Health – Page 3 – Integra LLC

Building While Operating: Lessons in linking mHealth and mobile money in Haiti

Last week marked two years since the devastating earthquake in Haiti that, according to the Haitian government, took the lives of 316,000 people[1], injured 300,000[2]and displaced at least one million people[3]– more than 10% of its population[4]. Any country’s infrastructure would struggle with this, but in Haiti even some of the smallest problems were exacerbated by the fact that Haiti was (and still is) the poorest country in the Western Hemisphere[5]. Many Haitians do have access to mobile phones, though, so mHealth and mobile money services have enormous potential to fill the gaps and improve their lives.

The earthquake left Haiti’s already weak health and financial systems in tatters. It destroyed 30 hospitals, 21 clinics, 11 Ministry of Health facilities, and 22 health training centers, and it damaged 30-40% of all bank branches and ATMs in the zone of impact. From the very beginning of the recovery, mobile services showed what they could do.

A great deal of mHealth activity took place to bolster the relief effort and safeguard reconstruction, including the Fletcher School /Ushahidi’s crisis mapping and proactive messages delivered via SMS to warn about cholera outbreaks through a partnership between Voila and the International Federation of the Red Cross and Red Crescent Societies, and more. In 2009, the Bill & Melinda Gates Foundation and USAID launched a prize fund to accelerate the launch of mobile money services in Haiti, enabling the population to send, receive, and store money via mobile phones. In the time that has followed, NGOs eagerly adopted mobile money as a safe, speedy way to distribute aid and pay people in cash-for-work programs. In fact, of the 14 mobile money use programs in the world, eight are in Haiti. These programs are realizing a range of benefits – including improved speed, efficiency, and security.[6]

This early flurry of activity is now giving way to longer-term questions. With the prize mechanism nearing completion, providers of mobile money services are looking for ways to expand them in a profitable, self-sustaining way. Haiti’s health system is rebuilding, and administrators are deciding how much to bring stopgap mHealth applications into the mainstream. And the opportunity to combine mHealth and mobile money through insurance plans, voucher programs, and other innovative services is just starting to open up.

Making these processes easier and realizing the long-term benefits of mobile services will require addressing a series of barriers in the public and private sectors:

Strategy to move from prize-led launch to sustainable scale. Mobile operators and banks must now determine their strategies to reach the mass market and move beyond the prize-led launch to sustainable scale, avoiding the sub-scale trap which many deployments face globally. This will require the consortia to prioritize, penetrate, and capture profitable segments of the Haitian economy.
Interoperability and integration. The central bank in Haiti did mandate interoperability between mobile money services, but there is a continued need to integrate services, bridges, and open APIs – especially if mHealth and mobile money are to work together.
The policy environment. At present, the lack of a national ID scheme and policies for data security and privacy are holding back the development of mobile services, particularly combinations of mHealth and mobile money. E-wallets have been used to register people in Haiti in place of national IDs, but the e-wallets are currently capped at US$250 by the central bank, limiting the usefulness of mobile services.
The evidence base. Greater distillation and dissemination of the experiences of providers, users, and regulators would help the sector to develop in a more directed and way, avoiding repeated mistakes and redundancies.

Both the mHealth and mobile money ecosystems are at an inflection point in Haiti, and there is reason to be optimistic. Favorable regulatory approaches have led to the emergence of a spectrum of products, including payroll and merchant payments. For the sector to preserve its momentum, providers will have to find new ways to attract consumers, and policymakers will have to keep up with providers’ and consumers’ needs.

[1]One Year After Haiti’s Quake: Cholera Babies School Without Walls, ABC News, 12 January 2011. Retrieved 7 January 2012.

[2]“Haiti raises earthquake toll to 230,000”. AP. The Washington Post. 10 February 2010. Retrieved 7 January 2012.

[3]“Haiti will not die, President Rene Preval insists”. BBC News. 12 February 2010. Retrieved 7 February 2012.

[4]“Earthquake Magnifies Haiti’s Economic and Health Challenges”. Population Reference Bureau. October 2010. Retrieved 7 January 2012.

[5] “UNICEF urgently appeals for aid for Haiti following devastating earthquake”, UNICEF, 12 January 2010. Retrieved 7 January 2012.

[6]Dalberg Global Development Advisors is currently conducting analysis for the Bill & Melinda Gates Foundation on the business case for, and operational learnings from, NGOs plugging into mobile money, forthcoming later this month.

January 18, 2012/by actualize

Agriculture, Health, Originally posted on the GBI Portal

2012: The Year to Speech-enable Your Healthcare App and Give Mobile Clinicians a Voice

With continued growth in mobile device adoption across care teams, it is more important than ever for healthcare applications to support the needs of clinicians so mobility can be obtainable, process-driven and lead to rich collaboration. And with this comes the need for better data entry methods as mobile device adoption and clinical application usage increases in the medical community (it’s estimated that 85% of clinicians will own a smartphone by the end of 2012).

In an effort to support this trend, the Nuance Healthcare Development Platform, which offers secure, cloud-based, medical speech recognition services to healthcare ISVs and provider and payer organizations, was launched early last year. With this platform and its medical speech services, healthcare developers are able to voice-enable their apps using just a few lines of code.

To kick off 2012, Nuance Healthcare is challenging health care developers to give mobile clinicians a voice by speech-enabling their web-based and mobile apps using the Nuance Healthcare Development Platform—looking for the best implementation of speech recognition for the clinician on the go that enhances workflow and improves patient care.

The 2012 Mobile Clinician Voice Challenge opens Monday, January 2, 2012 at 9:00AM EST and closes Friday, February 3, 2012 at 5:00PM EST.

Watch a 60-second video describing the challenge at http://www.youtube.com/watch?v=n4aGA7bmr7M

Take the challenge today and learn more at http://www.nuancehealthcare.com/2012mobilechallenge

January 4, 2012/by actualize

Agriculture, Health, Originally posted on the GBI Portal

Public Health Informatics Certificate Training Program

The Johns Hopkins Bloomberg School of Public Health
Public Health Informatics Certificate Training Program
Tuition Subsidies Available*

Application Deadline March 15, 2012

Public Health Workers in the Community Encouraged to Apply

Targeting public health professionals, The Johns Hopkins Bloomberg School of Public Health, in collaboration with the Johns Hopkins Schools of Medicine and Nursing and the Public Health Data Standards Consortium (PHDSC), is pleased to announce that the Public Health Informatics Training Program is accepting applications. This program results in a Maryland State-approved Post-Baccalaureate Certificate in Public Health Informatics.

The goal of the program is to offer training in methods and concepts of health informatics and health information technology for application to public health. It is designed for current and future public health professionals who wish to develop expertise or specialization in this area. Courses for this program are available completely online. Individuals residing in the Mid-Atlantic region may also take selected courses on site.

The training program focuses on the following core informatics topics:

Overview of public health and biomedical informatics
Health information systems design and development
Health information technology standards and systems interoperability
Systems evaluation in health sciences informatics
Population health informatics

Electives are available in: Knowledge Engineering and Decision Support; GIS; Real-Time Surveillance; and “eHealth and mHealth.” The program culminates with a practicum, working on an approved public health informatics project.

Tuition Funding

Qualified applicants are eligible for a $10,000 tuition subsidy via a grant from the Office of the National Coordinator for Health Information Technology (ONC), US Department of Health and Human Services. This subsidy is available on a competitive basis and with receipt of the award, the total tuition and fees that the student or employer will be required to pay to complete the certificate requirements is approximately $9,200. The ONC sponsored scholarship program is especially interested in applicants currently working within US public health agencies who wish to re-tool to specialize in public health informatics.

* Only US citizens or verified permanent residents are eligible for the ONC tuition subsidy. Those awarded the subsidy must complete all certificate requirements within 12 months. Priority for the tuition subsidy will be given to professionals currently employed in the public health field within the US or those intending to enter the domestic public health field. The tuition subsidy is not intended for those already working on a full time basis in the public health informatics field. All tuition subsidy awards are subject to ONC approval.

Applicants not eligible for the ONC funding can expect to pay approximately $19,200 to complete the certificate program and are permitted up to 24 months
to complete the certificate courses.

Certificate Application Eligibility

The certificate in Public Health Informatics is open to both current degree candidates at the Bloomberg School of Public Health as well as those with no School affiliation working in the field of public health who are seeking to move into the informatics field. Credits earned in the certificate program may be applied towards other Johns Hopkins degree programs – such as the MPH or informatics MS – if accepted into a program at a later date.

Eligibility requirement for the certificate include either: 1) an earned graduate degree in public health; or 2) current enrollment in graduate public health degree program; or 3) a bachelor’s degree and a minimum of 3 years of direct public health experience.

The next cycle of training will commence in late August of 2012. The application deadline for entry into this cohort is March 15, 2012.

More information about the Public Health Informatics Certificate Training Program, including application forms and detailed instructions, can be found at:
http://www.jhsph.edu/dept/hpm/certificates/informatics

If, after carefully reviewing the program web site, you have further questions, please contact Ms. Pamela Davis, the program coordinator at pdavis@jhsph.edu or 410-614-1580.

As part of the Johns Hopkins University-wide health informatics training, two other programs (also with subsidies funded by the ONC) are available for medical, nursing, information technology, software engineers, and clinical management professionals without public health experience. These other programs are hosted at the Johns Hopkins School of Medicine and School of Nursing. Information on these other programs for professionals without public health experience can be found at: http://www.jhu.edu/healthIT

Order:

December 22, 2011/by actualize

Agriculture, Health, Originally posted on the GBI Portal

Inaugural meeting of the Technology Standards & Interoperability Working Group

The inaugural meeting of the mHealth Alliance’s Technology Standards & Interoperability Working Group was held on December 20th, 2011. There were 11 attendees representing varied groups including: donors, academics, implementers, clinicians and technology providers. A zip file is attached to this blog; it contains an audio recording of the meeting (with the chair’s thanks to Ricardo Leitao of Andago).

The (draft) mission of this new working group is to: Achieve alignment on and adoption of standards which support greater interoperability amongst mHealth deployments to ensure improved continuity of care, technology re-use, and cost effectiveness. The mHealth Alliance’s two key strategic focus areas for 2012 are: Evidence and Interoperability.This working group is intended to give effect to the latter.

There was helpful and insightful discussion regarding the ways both a “top down” and a “bottom up” approach can usefully inform the group’s activities — with examples given of each. As a “homework assignment”, group members will digest and comment on the two work items that are already posted to HUB, and will begin posting other artefacts (requirements docs, architecture diagrams, etc.) that provide informative examples from initiatives in the field. We will also start to catalogue a list of projects (especially open source examples, please) that illustrate “going to scale” with m/eHealth technologies in low resource settings.

I wish to thank the attendees for their active and helpful participation. I also hope that the audio recording will help others who were unable to make the scheduled time-slot to “join” and would welcome any and all comments (please post to this blog) they might like to add.

Our next meeting will be scheduled early in the new year. Between now and then, I wish everyone a safe and happy holiday season and all the best in 2012!

-Derek Ritz

Initiative:

mHealth Systems Integration

December 22, 2011/by actualize

Agriculture, Health, Health, Maternal & Child Health, Originally posted on the GBI Portal

Don’t Miss Raj Shah on 20/20 Tonight!

BY: Raj Shah, U.S. Agency for International Development (USAID) Administrator

This Post originally appeared on ABCNews.

Raj Shah holds up his hads, with the words 1 million moms written on his palms Ensuring the safety of a mother and her newborn is not only one of the greatest development challenges we face, it is also one of the most heartbreaking.

Earlier this year, I visited South Sudan, where I met school children studying in a classroom—some of them for the very first time. Although I was optimistic about their future, I was also concerned, because I knew that for every girl I met, she was statistically more likely to die in childbirth than complete a secondary education.

This reality is simply unacceptable.

There is an incredible need to ensure the safety of mothers and infants in the critical period of 48 hours surrounding birth. To help spur progress in maternal and child health, we launched our first Grand Challenge for Development – Saving Lives at Birth – in partnership with the Government of Norway, the Bill & Melinda Gates Foundation, Grand Challenges Canada and The World Bank.

Saving Lives at Birth calls for groundbreaking prevention and treatment approaches for pregnant women and newborns in rural settings during this perilous time around childbirth. We received more than 600 proposals to our Grand Challenge, more than a quarter of which arrived from the developing world. Last week we announced our three transition-to-scale grant nominees. These nominees have proven that their ideas can deliver real results in local communities and are ready to test them on a much larger scale. While we expect our first round of grants to yield exciting innovations with the potential for significant change, we will encourage our community of innovators to push boundaries and find new ways to shape collective action.

Similarly, the Million Moms Challenge is inspiring American families to help mothers and children around the world. I am proud to accept this Challenge and will continue my commitment to this important cause.

I hope you will too.

December 16, 2011/by actualize

Agriculture, Health, Originally posted on the GBI Portal

Weaving eHealth Into the Fabric of the African Health System

The 4th Afrihealth Conference, held in Nairobi, Kenya on Nov. 30 and Dec. 1, broadened the debate on the adoption of Telemedicine, mHealth and eHealth in Africa, and brought attention to the need to integrate and mainstream eHealth into the continent’s health system.

The theme of the conference was “consolidating the gains of technological innovation in healthcare through effective management,” and some debate sparked on what direction to take eHealth in Africa.

According to Science and Development Network reporter Maina Waruru, experts attending the conference argued that “a focus on high-tech healthcare solutions could come at the expense of basic prevention such as access to clean water and sanitation, good nutrition and hygiene, and health education.” Since 80 percent of illnesses in Africa stem from preventable infectious diseases, this focus on high-tech is a move in the “wrong direction.”

But the potential for using ICTs to continue to improve basic healthcare in Africa is great, and a focus should be on ensuring that appropriate technology is utilized and effectively delivered.

One concern attendees brought up was the lack of a legal framework to determine what qualifies a person to work as an “e-health” professional. E-health is often practiced by non-professionals such as ICT technicians and nurses, and many countries have not established what qualifications are needed to be certified as a professional.

In addition, physicians in many countries are of an older generation and received their degrees before the ICT explosion. Many are not comfortable with situations where they consult with patients remotely, without actually being in the room with them.

Image from Dr. Kwankam's powerpoint presentation at Afrihealth conference

From Dr. Kwankam's presentation at Afrihealth 2011 conference

To address some of these issues, Shariq Khoja, the coordinator of the e-health program at Aga Khan University, has suggested that laws should be put into place to “accommodate and mainstream [e-health].” According to Dr. Yunkap Kwankam of the International Society for Telemedicine and eHealth, “for eHealth to take root and thrive…it must itself be transformed…we must weave eHealth into the fabric of the health system.”

Dr. Kwankam claims that Africans can benefit from technology changes by effectively managing it and charting a course for ICT in health through an organized eHealth profession, national eHealth policies and strategies, and addressing large eHealth challenges, such as scaling up eHealth interventions.

Dr. Kwankam and other experts’ presentations from the conference are now available.

December 7, 2011/by actualize

Agriculture, Health, Health, HIV/AIDS, Originally posted on the GBI Portal

CrowdOutAIDS: Engaging Youth to Develop AIDS Policy

CrowdOutAIDS, the online crowdsourcing project that engages young people in developing a UNAIDS strategy on youth and HIV, has wrapped up its fifth week. The project launched in October 2011 and will run for two months, with the final crowdsourced strategy to be produced in January.

Crowdsourcing is a technique used to quickly engage large numbers of people to generate ideas and solve complex problems. CrowdOutAIDS’ target “crowd” is young people, 3,000 of whom become infected with HIV every day and 5 million of whom currently live with the virus.

The project’s approach is to follow a four-step model:

Connect young people online
Share knowledge and prioritize issues
Find solutions
Develop collective actions on HIV

Once the fourth step is completed, the UNAIDS Secretariat will put the youth strategy into action, and the strategy could become an advocacy platform in future UNAIDS work.

Currently the project is in the second stage of sharing knowledge. Youth from all over the world have been connected through eight regional Open Forums that are in Arabic, English, Spanish, French, Russian and Chinese. The moderator of each forum starts each day with a question (such as “What is your description of a healthy relationship?”) and participants respond and interact with one another.

The first week of the project revealed some of the major problems, in the eyes of youth participants, with UN agencies’ current approaches to working with youth. Participants expressed concerns that UN initiatives of working with youth in HIV response lack strategic vision and have no clear plan, and hinder young people from participating in decision-making.

It will be interesting to see what solutions are developed after the knowledge sharing step is completed, as well as what direction the UN youth and HIV strategy takes over the next six weeks. Be sure to check out the CrowdOutAIDS website and Twitter @CrowdOutAIDS for continuous updates.

November 28, 2011/by actualize

Agriculture, Health, Originally posted on the GBI Portal

Mobile Health App Launched in Kenya Will Increase Access to Healthcare Information

MedAfrica, the Nairobi-launched mobile health app that makes basic health information more readily available through phones, is generating buzz in mHealth for Africa.

The app was developed by the start-up tech firm, Shimba Technologies, and boasts a sustainable, innovative business model. Shimba CEO Steve Mutinda says the tech company “aims to achieve by creating platforms that facilitate dissemination of information and build communities around the different issues and conditions [in health] while at the same time converging all stakeholders and amplifying their efforts.”

The platform provides information such as doctor and hospital listings, drug authenticators, and lists of symptoms with suggestions for self-diagnosis. This sort of symptom checking could be very useful in countries like Kenya, where as little as 14 physicians exist for every 100,000 people. Members of MedAfrica explain that because the app is providing such valuable information to clients, as well as recommending good doctors and dependable, lab-tested drugs, users are willing to pay for the service.

Originally meant to provide health information solely in Kenya, MedKenya was the overall winner for the East African mobile tech event Pivot25 competition. Changing the name to broaden the app’s potential scope, MedAfrica presented at Demo Fall 2011; in video below, VentureBeat interviews Mutinda and a colleague.

The best news about the launch of the app is its potential scalability. The organization wants to use its launch in Kenya as a road map to scale the product to other African countries. MedAfrica’s mission is to reach every household in Africa.

The content for the app will come from partners such as the Nairobi Hospital and open data from the Kenyan government. During the launch, Kenya’s ICT Board Chairwoman Catherine Ngahu called on other medical institutions, physicians, and health providers to supply content for the app as well.

Given Kenya’s track record in developing some of the most innovative apps in Africa, if not the world, it’s no surprise that MedAfrica has garnered so much attention and holds so much hope for expansion.

November 9, 2011/by actualize

Agriculture, Health, Mobile, Originally posted on the GBI Portal

Is mHealth Taking Off in the Middle East?

A recent report compiled at the United Arab Emirates’ Mobile Show illustrates that citizens overwhelmingly believe that the mobile industry in the Middle East can have a positive effect on the health sector, emphasizing the great potential for mHealth in the region.

Mhealth – or mobile health – is a consistently reported topic in the ICT4D field, with projects popping up in developing countries on a daily basis. While many of these projects are being undertaken in sub-Saharan Africa and Southeast Asia, there is less news on mHealth initiatives in the Middle East.

Photo credit: mHealth Insight

Take Health Unbound (HUB), for example, the mHealth Alliance’s open source database of mHealth projects around the world. Of the 217 projects in the database, only about 8 are located in the Middle East, as opposed to 37 in Southeast Asia and a whopping 109 in sub-Saharan Africa.

But recent reports indicate that more attention is being given to mHealth in the Middle East. One article states that the Middle East has been a “hotbed for mHealth development,” reporting on various mHealth initiatives in the region. Qatar’s Supreme Council of Health announced that it will launch an app that locates clinicians, physicians and other health resources in the country, and two mobile companies in Qatar have partnered up to offer health and wellness education using mobile phones. In addition, the first mplushealth conference will take place at the Arab Health Exhibition and Congress in Dubai in January. The conference will bring together healthcare professionals, insurance providers, government regulators and telecommunications decision-makers to explore mHealth opportunities in the Middle East and hopefully pave the way for the sector to thrive.

The UAE Mobile Show report also revealed challenges that need to be overcome before mHealth can take off in the region. 73 percent of respondents indicated that patient-physician confidentiality was a major concern in implementing a mobile health system, as well as privacy, security, high costs, network infrastructure and technology.

Photo credit: AMEinfo.com

These obstacles may be part of the reason that mHealth initiatives in the region have remained primarily in the hands of independent mobile app developers, without much governmental support. But as attention on mobile health in the Middle East continues to grow, the region could be one to watch for future mHealth innovations.

November 1, 2011/by actualize

Agriculture, Health, Health, HIV/AIDS, Originally posted on the GBI Portal

Monitoring and Evaluation in mHealth: Opportunities and Challenges

Last week’s mHealth working group meeting laid out the opportunities, challenges, and potential of monitoring and evaluation (M&E) within the mHealth sector.

JhPiego circumcision promotion through texting service

Poster in Swahili promoting male circumcision through SMS service, part of Jhpiego program

Several experts in the field presented their experiences of monitoring and evaluating mHealth projects, emphasizing the considerable potential that mobile projects offer in generating robust and accurate data. Kelly L’Engle, a behavior scientist at FHI 360, discussed the need for M&E in order to gauge the impact of mHealth. She claimed that mHealth technology is not being fully leveraged and that the current mHealth research “doesn’t provide evidence on actual impacts…or answers to critical research questions…”

James BonTempo from Jhpiego presented on evaluating behavior change evidence from a text message project that promotes male circumcision (MC) for HIV prevention in Tanzania. He referred to this evidence extraction as “mining the data exhaust” – that is, the data generated as a byproduct of ICTs, the “trail of clicks” that ICT users leave behind.

The MC program offered a toll-free text-messaging/SMS service. With the service, individuals could request to receive information on the benefits of MC (using key word: TOHARA), where to find MC services (WAPI), as well as receive follow-up care information after undergoing the circumcision (BAADA). While the SMS platform was intended to capture requests to the three keywords and generate access logs for system performance monitoring, Jhpiego has analyzed this data in order to see if there was a relationship between requests for the MC data and actual utilization of MC services.

Jhpiego male circumcision project in Tanzania- behavior change evaluation

Potential link to behavior change in Jhpiego male circumcision project

The data set included 12,056 keyword requests sent by 4,954 users. After performing a Chi Square analysis on the data, the project team found that requests for information on the benefits of MC (TOHARA) was not strongly associated with going to receive the circumcision. However, it was found that those who requested where to find the data (WAPI) did have a statistically significant association with undergoing the circumcision. These results are consistent with pathway models of behavior change, indicating that those who simply wanted to know more about MC were not quite prepared to undergo the procedure, but those looking for service availability were ready to use the services.

The associations found in this particular project imply that providing text or voice messages that tell people where to get a particular service could be more effective in encouraging clients to utilize that service. M&E that finds results such as these could help project leaders design SMS services that generate more useful data.

Like most forms of M&E, there are limitations on findings that use mobile data. There is a lot of information that mobile devices do not provide, such as which phones belong to whom and who actually sends the text messages; this makes it difficult to link messages to specific individuals. In the MC case, data analysts found an association, but did not necessarily know the nature of the association. It can also be challenging to find the time or manpower to rake through the massive amount of data that is produced by mobile devices.

While M&E in mHealth has its limitations, it is difficult to find data that can be collected and analyzed as quickly, cheaply, or easily using other means. Paper, radio, and television simply do not offer the same kind of easily-mined data exhaust that mobile does.

October 25, 2011/by actualize

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