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USAID MAMA initiative leading the way in mobile for maternal health projects

The USAID-initiated MAMA (Mobile Alliance for Maternal Action) project that utilizes cell phones to improve maternal health in developing countries gave an in-depth update at the latest mHealth Working Group meeting.

The pilot initiative, announced in May by Secretary of State Hillary Clinton and co-sponsored by Johnson & Johnson, has begun work in Bangladesh. MAMA seeks to achieve “scale, sustainability and impact” by creating a replicable model of reaching low-income mothers and household decision-makers (husbands, mothers-in-law) through increasing the impact of current mHealth programs, providing technical assistance to new mHealth models, and improving methods of applying mobile technology to improving maternal health.

At the working group meeting, Sandhya Rao of USAID and Pamela Riley of USAID’s SHOPS (Strengthening Health Outcomes through the Private Sector) program discussed the status of Aponjon, the MAMA project in Bangladesh. Aponjon provides vital health information through mobile phones two times a week to expecting and new mothers, reminding them of when to receive checkups and how to stay healthy during the pregnancy. Bangladesh was chosen to pilot the project because the country’s government has been a leader in promoting and expanding access to ICTs and is very active in mHealth.

Mom uses text to check in with doctor

Photo credit: Council on Foreign Relations

In order to bring it to a national scale, the burgeoning MAMA initiative has established private, public, and NGO partnerships to help implement its activities, and is carefully monitoring its methods and practices to ensure that the project is reaching its target goals. For example, Aponjon is constantly tweaking the content of its phone messages so that mothers and decision-makers understand, retain and relate to the information given.

Keypad for cell phone

Photo credit: Highmark Medicare Services

Another aspect of the project that MAMA will be monitoring is its business models to determine which are the most sustainable and effective. Currently, customers pay service providers to retrieve the phone messages. Text messaging is the cheapest method for remitting information in most developing countries, but many of the poorest clients are unable to read the texts. The alternative is interactive voice response (IVR) through which customers can hear recorded messages at a much lower cost than call centers but more than texting. MAMA and its partners are experimenting with different pay schemes, such as subsidizing rates, working with service providers to offer low rates or donate funds to the project, and charging fees based on usage.

It will take the new initiative years before sustainable, reliable, and replicable models are in place. What is clear is that the potential for improving maternal and newborn health through the use of mobile phones is being tapped.

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Arogya World announces diabetes prevention mHealth program in India

 

Arogya World, a US based NGO, in association with Nokia, will be launching a large-scale diabetes prevention mHealth program in India. The diabetes awareness program aims to reach one million people over the course of the next two years through the use of text messages, which will be translated in multiple languages, catering to the diverse population in India.

The announcement was made at the 2011 Clinton Global Initiative (CGI) Annual Meeting in New York City.

 

For more information, read the official press release here.

 

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Scalable and Replicable: ICT4Health is Chosen Theme for UN South-South Awards

Digital Health 4 Digital Development was the theme of choice for the 2011 South-South awards that took place earlier this week. The United Nations-supported awards ceremony, held September 19th, honors governments, organizations and individuals accelerating progress toward the Millennium Development Goals (MDGs), and this year awards were given for utilizing ICTs for the advancement of the MDG health goals.

Prime Minister of Bangladesh receives South South award from

Photo Credit: thefinancialexpress-bd.com

The awards were organized by South South News, a digital media platform launched by the United Nations General Assembly High-level Committee in 2010. The platform disseminates development news and allows countries in the global South to share best practices in advancing implementation of the MDGs. As health remains a high priority within the international development field, with three of the eight MDGs calling for health improvements by 2015, this year South South chose the “catalytic and unifying force of ‘digital health’” as its focus.

Awardees were recognized for policies, programs and projects that address global health using ICTs as a mechanism for “scalability and replicability of the broad development agenda.” Awards were given on health categories such as Women and Children’s Health and HIV/AIDS, TB and Malaria with special consideration given to achievements in the fields of mobile, broadband, Internet, medical, and pharmaceutical applications.

Among the winners was Bangladesh’s prime minister Sheikh Hasina who received recognition for the use of ICTs in addressing women and children’s healthcare. The government of Bangladesh has made increasing the use and availability of ICTs a priority over the past decade, declaring IT a “thrust” sector and implementing a national ICT policy in 2002. The prime minister has been a catalyst for ICT development in Bangladesh, launching the Digital Bangladesh 2021 program, reducing taxes to make computers and other electronics more affordable, and giving free internet services to schools. This is not the first time she has been recognized for her ICT work in the country. The PM noted during the ceremony that most of Bangladesh’s 11,000 community health clinics have been digitized, allowing for free treatment of diseases like malaria and AIDS and reducing maternal and infant mortality rates.

Use of PDA by the nurses at ICDDRB hospital in Dhaka, Bangladesh

Photo credit: Bytesforall "ICT4Health" Network

Other development agencies and UN-affiliated organizations are also choosing to give awards to those using ICTs to advance public health initiatives. The Elena Pinchuk ANTIAIDS Foundation, rising from the work of UNAIDS High Level Commission on HIV Prevention, has launched a competition to find innovative start up projects that use social media and mobile phones for HIV prevention. The competition is taking applications until October 1st and the winners will receive up to $10,000 to implement one-year projects.

As global health becomes a pressing priority, it is essential to utilize, innovate, and increase access to ICTs within the healthcare sector. The South South awards have set a precedent by recognizing the success of ICT4Health in accelerating the Millennium Development Goals and could encourage Global South countries to follow in the footsteps of nations like Bangladesh.

 

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Beyond “an App for that”: Using mHealth to fight NCDs

As the global health community gears up for the upcoming  United Nations High-Level Summit on non-communicable disease (NCDs), I thought it would be useful to explore the ways in which mobile technology can play a role in the efforts to reduce the burden of NCDs globally.  NCDs include cardio-vascular disease, diabetes, cancer, and chronic respiratory diseases. The combined impact of these diseases contributes substantially to global poverty rates and places strain on healthcare systems worldwide.

With a growing urban population and lifestyle changes, particularly in diets where fast foods have become a greater part of the local diet, obesity and diabetes rates tend to grow rapidly.  NCD rates are frequently driven by the combination of lifestyle changes and environmental shifts and require more innovative thinking around behavioral change and social movements in order to make long-term changes.

mHealth applications for NCDs are already quite common in parts of the world where diabetes rates, in particular, are high. This can be found in personalize-able mobile applications such as Glucose Buddy, or in social media campaigns such as TuAnalyze, which uses Twitter to drive higher compliance rates for hemoglobin A1c testing (a bit of a gold-standard when it comes to diabetes care).

Beyond diabetes, there are NCD prevention applications, such as the anti-smoking Text2Quit, demonstrating the potential to find interventions with the capacity to scale into national campaigns. On the respiratory disease front, Asthmapolis, is an innovative approach that combines sensors with mapping to track the contexts in which people with asthma use their inhalers and furthers our public health understanding of asthma and the environment. Tracking programs that enable dieters to monitor food intake and exercise can be effective tools for fighting obesity and cardio-vascular disease.

In order to realize the full potential of mobiles, however, we should take a few cues from the recent mass mobilizations and social movements in the Middle East where Facebook and Twitter were utilized to facilitate social change movements in Egypt and Tunisia.

Similarly, long-term efforts at prevention in public health have rarely succeeded without complementary sustained social movements that reduce the social barriers to behavioral change and create stronger enabling environments for personal lifestyle changes to succeed. This could include more walkable cities, better access to health foods, and changing environmental drivers that affect cardiovascular diseases and respiratory health outcomes.

We’ll likely need to move beyond the “app for that” ethos to engaging with social networks and technology in ways that can promote both well-being and the underlying social transformations required to sustain behavioral change in a health landscape that must navigate a long-term global financial crisis where resources are in short supply.

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India to use mobile phones to track millions of immunizations

Child being given vaccination. Photo Credit: getty images

India’s health minister announced earlier this month a new initiative designed to boost the country’s rate of immunizing newborns by collecting mobile phone numbers of all pregnant mothers to monitor their babies’ vaccinations over time.

Ghulam Nabi Azad, the health minister, told a World Health Organization meeting in New Delhi that his ministry has been supervising the collection of about 26 million mobile numbers of pregnant women in India since January and plans to finish the job by December.

The women whose numbers are collected will be tracked via the mobile phones in the future by the Indian government to ensure the women’s babies receive the proper immunizations at the proper times. Babies in India are supposed to be immunized against tuberculosis, polio, diphtheria, tetanus, whopping cough and measles, health experts say.

According to Mr. Azad, the campaign will “enable us to monitor our immunization service at a national level. In addition, the central government will be able to check on the accuracy of data collected locally, which is often in doubt.”

The impetus for this program manifested due to a decentralized and deficient public health system, poor monitoring methods and sub standard vaccination coverage.

Photo Credit: wisdomblog.com

In 2010, only 72% of Indian babies received the three doses of the DPT vaccine against diphtheria, tetanus and whooping cough, an accepted indicator of a successful vaccination program, according to a joint estimate United Nations Children’s Fund and the WHO. That compares poorly with Bangladesh at 95% and Indonesia at 83%, according to the same joint estimate.

An inherent problem with the monitoring of vaccinations in India is that once babies are vaccinated, there tends to be no physical record of that baby being vaccinated. It is up to the guardians of the child to remember which vaccination was administered at which time. Also, the district levels governments may report erroneous numbers when reporting on the number of children vaccinated.

This initiative will give the central government the ability to contact the new mothers to confirm their babies’ immunization. “We’ll know the capacity of each state so they can’t fool us,” said Mr. Azad, reflecting widespread frustration.

Such an encompassing initiative is bound to face obstacles. Mr. Azad already encountered problems when he tried calling ten numbers from a list gathered back in February. “In front of all of the ministers, I picked up the phone and dialed the first 10 numbers. Only six of them were accurate numbers. Knowing we were going to be checking these numbers, our health workers still collected 40% faulty numbers—that is very bad” he said.

Mr. Azad declined to detail the cost of the program or how many numbers have been entered into the government’s system so far. But he said that tracking 26 million babies “is not an easy job.”

This is an ambitious project to say the least. Mobile phones after all aren’t permanent tools. A family could potentially report one number and procure a new phone with a new number. Also keep in mind, the Indian government is talking about a series of vaccinations that will span over a number of years for families living in rural areas. There could be a high turnover issue of mobile numbers. Families could also report a false phone number for fear of government intrusion – there is no way of double checking for that. Don’t forget, not all mothers will have a mobile phone to begin with.

The list of possible impediments could go on, but the bottom line is that attaining 26 million accurate and functional mobile numbers is idealistic at best. Nonetheless, this is a good start for the central government – it shows they are paying attention to the issue.

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Tanzania tracks malaria prevention with mobile phones

Photo Credit: medatanzania.org

In Tanzania, a new voucher program started in late July that provides discounted insecticide treated bed nets for pregnant women and children. This program also takes advantage of mobile technology as retailers can inform local clinics when their shops are getting low on life saving supplies by text messaging.

The program which is being overseen by MEDA, a Canadian organization, integrates health clinics, wholesalers, retailers and bed net manufacturers. Pregnant women and families with children in rural areas are eligible to receive a voucher from health clinics to get discounted insecticide treated bed nets from health supply retailers at 500 Tanzania shillings (about $0.35).

Once a woman takes a voucher to a retailer and pays a discounted price, she receives a bed net in return. The retailer then uses his or her cell to send a text message back to MEDA, which helps run the program. That SMS provides crucial monitoring data that includes the number of bed nets provided to the community and how many are needed in their next shipment.

The use of mobile technology to monitor bed net stocks and shipments is the feature that set this bed net initiative apart from others.

Each shipment contains a predetermined number of bed nets for a specific region based on their unique needs. Once the bed nets are delivered and the vouchers are collected, the retailers receive monetary compensation.

Long lasting insecticide treated bed nets. Photo Credit: medatanzania.org

In the “fight” against malaria, insecticide treated bed nets are a cost effective and proven weapon, especially for families in rural communities. According to the Global Fund, more than 300 million bed nets have been distributed in Sub-Saharan Africa since 2008. Moreover, Tanzania is a hard hit country as 2 million out of the 44 million people are affected by malaria.

Distributing vouchers for discounted bed nets is not a new method of tackling malaria. However, this approach produces a different sentiment amongst bed net owners than simply passing out bed nets to families for free.

Health workers have found that when a family makes a small investment in the net, it becomes a more valued commodity. Initiatives that pass out bed nets for free sometimes fail because families adopt the mentality that bed nets are valueless and easily replaceable.

This program distributes paper vouchers to the women that visit health clinics. Paper vouchers can easily be lost or ruined altogether. Therefore, keeping track of paper vouchers is often an obstacle. The next step is eliminating paper vouchers and developing text message based vouchers to make the process more efficient.

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Youth rewarded with food and medicine for going to school

Child using the mPowering mobile app. Photo Credit: fastcompany.com

Can children in impoverished areas that sacrifice school to make an extra dollar for their family be given the opportunity to go school without worrying about the family?

One organization is taking a stab at breaking that crippling cycle. mPowering, a nonprofit organization that aims to use mobile technology to empower the impoverished to climb out of poverty has implemented a mobile phone program that provides children with food and medical incentives for going to school.

The organization, founded by veterans of Salesforce.com and Apple, is partnering with nonprofits in the developing world to provide food, medicine, and other goods to people in places like Orissa, India who perform poverty defeating actions like going to school or taking advantage of prenatal care.

mPowering employs a plan for finding the right population to work with. They pinpoint areas in the developing world where poverty is widespread and then partner with local organizations in those areas to develop mobile phone programs that facilitate a path for climbing out of poverty.

Photo Credit: mpowering.org

One area mPowering is currently working in is Orissa, India, the poorest region in India with over 20 million people living in extreme poverty. In Orissa, mPowering has partnered with the Citta foundation to build a school, hospital and establish the mobile phone program.

Forty-nine families in the region were given phones by the Citta foundation, which they now use to document when they go to school or attend local health care classes for expectant mothers.

A child going to school, for example, logs in to the “school” option on the mPowering mobile app and scans his barcode to check in. The app is entirely picture-based, so users don’t have to be literate. At the end of each month, the families pool together their points to score medicine, food, and clothing from the nonprofit partners, in Orissa’s case, the Citta foundation.

The idea behind mPowering is to attack the phenomenon of children dropping out of school to work for their families and not being able to afford healthcare while doing so. This is critical since 41% of Orissa’s children suffer from malnutrition, and 65% suffer from anemia.

Providing food and medicine incentives for going to school has a two sided effect. It gives the family the supplies they would have the children work for, and it motivates the child to go to school and stay enrolled.

mpowering mobile app interface. Photo Credit: fastcompany.com

Many of the potential obstacles have been accounted for. A program manager is responsible for monitoring and distributing the incentives to families every month. Also, phone chargers are provided to schools so that families without electricity can charge their phones at schools while the children attend class. mPowering also holds training sessions for the families who receive their phones.

Breaking out of the cycle of poverty is a difficult and tricky thing to do. However, tackling the problem through children may be a fruitful avenue to go through given that children who are impoverished grow up to perpetuate the cycle all over again with their families.

 

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Study shows importance of evaluating mHealth programs

One the biggest issues in mHealth and mobile campaigning in the developing world is the lack of evaluation. Well, the Lancet published an article last week that measured the effectiveness of mobile phone text message reminders on Kenyan health workers’ adherence to malaria treatment guidelines.

What the study found was that text messages can be a cost effective way to improve the care for malaria treatment in African children. Even though the study focused on malaria treatment, the results of the study suggest that using text messages can be an effective weapon to fight many different health burdens with.

According to the study, half of children received the correct treatment at the end of the study, more than double the starting figure. At the beginning of the study, 20.5% of children were correctly managed, this increased to 49.6% after the six month study.

The effect appeared to persist after the texts stopped. Six months after the trial ended, 51.4% of children were receiving the correct treatment due to the text messaging.

Professor Bob Snow, who headed the research group, said, “The role of the mobile phone in improving health providers’ performance, health service management and patient adherence to new medicines across much of Africa has a huge potential.”

Despite the positive numbers, the authors acknowledge that “we do not fully understand why the intervention was successful”. They speculate that the presence of the texts themselves serve as a reminder and reinforce the importance of the message itself.

One of the conclusions in the study is that “text-message reminders should be used to complement existing interventions—which themselves should be qualitatively improved—to target weak points” in health management practices.

The study however, sheds light on the importance of evaluating an mHealth campaign. Through evaluations, stakeholders can figure out whether a program is meeting its goals and how much of an impact it is making on the health issue it was designed for.

Currently in the developing world, numerous mHealth programs are being implemented on a small scale basis without monitoring and evaluation components. This not only leaves the project unfinished, but it is irresponsible as well. If a given program is appropriate to scale up to a wider population, we would never have the statistics to prove it. Then again, that hasn’t stopped NGO’s and governments before.

Evaluating mHealth programs is not a complicated task. Perhaps stakeholders are afraid to discover that their programs are not actually producing the impact they envisioned in the board room. This study has shown that positive results can indeed manifest from text messaging campaigns, and it is worthwhile to evaluate such campaigns.

The world needs to know what works and what doesn’t for the sake of the populations that are supposed to be the beneficiaries of the programs they are involuntarily thrown into. Otherwise, stakeholders are shooting in the dark with the well-being of innocent people.

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New app gives Thailand’s healthcare chance to go paperless

A doctor using the Family Folder Collector app on an Android pad, collecting information on a member patient. Photo Credit: bangkokpost.com

Thailand’s public health system has developed a mobile app for Android enabled tablet PC’s to monitor and collect household information on patients. The app, called Family Folder Collector (FFC), was developed by a research team at the National Electronics and Computer Technology Centre (Nectec).

Nectec researcher Watcharakon Noothong said the application comprises three major programs, including a walking map, genogram (a pictorial display of a patient’s health and family relationships) and Java Health Center Information System (JHCIS) synchronization.

FFC is designed to make life easier for public health workers who collect data on patients and for patients who are on time sensitive treatment schedules and cannot travel to health stations at any given moment for treatment.

The app is free. The only cost to utilize the service is paying for the tablet PC’s which is being covered by the province’s public health office.

Here are some of the features and capabilities of the FFC app:

  • Google maps shows the exact location and number of households in a given area
  • Genograms can be displayed
  • Chronic disease frequency can be color coded on a house-to-house basis
  • The program can collect and store other vital data, such as a patient’s weight, height, blood pressure and pulse rate, and even calculate a patient’s body mass index (BMI) automatically.
  • The program provides forms for treatment results, initial symptoms, health recommendations, and health behaviors
  • Doctors can schedule future appointments with patients
  • In the near future, the program will also be able to send an SMS to alert patients to get treatment at the health station.

All the collected data is updated and stored on the Android device then synchronized to the JHCIS database server. Public health workers were trained on how to properly input data into the tablet PC’s before pilot testing started. Of a total of 25 districts in the province of Ubon Ratchathani, eight are running the pilot trial of the FFC program, which, in its first phase, covers 123 health stations.

Ubon Ratchathani was chosen as the province since its existing IT infrastructure can accommodate sophisticated ICT’s for healthcare. There are over 1.8 million people in the province, all of whom will be accounted for by health workers using the FFC app.

This do-it-all app is a valuable tool for public health officials and physicians in Thailand. FFC can potentially replace the paper based system of collecting data and monitoring patients in Thailand.

The FFC application can display a genogram, monitor chronic diseases with Google Maps, and locate the house coordinates using a GPS system. Photo Credit: bangkokpost.com

The potential benefits of using this service are bountiful. Patient data will be gathered much easier and will be much harder to lose over time. Doctors can schedule appointments and prescribe treatments without physically seeing patients. Also, analysis of patient data will be faster, more efficient and more accurate.

Thailand may experience a revolution in healthcare if this service lives up to its potential. Currently, each health station has one tablet PC equipped with the program. The FFC application is expected to run throughout the province covering all 346 health stations by 2012.

Furthermore, according to Sinchai Tawwuttanakidgul, director of ICT Centre, Office of the Permanent Secretary, Ministry of Public Health, today there are some 45 provinces that are ready to switch from their paper-based system to the FFC mobile application. It sounds like Thailand is ready to experience that revolution soon.

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To UNICEF and WHO: Don’t forget to monitor your vaccines

Children and women waiting to get diagnosed in clinic. Photo Credit: WHO

In the wake of the drought and famine being experienced in the Horn of Africa, multiple vaccination campaigns have been launched in the region. UNICEF, WHO and Kenya’s Ministry of Health (MOH) are launching a campaign for the children situated in the Dadaab refugee camp in Northern Kenya, which is already triple the amount beyond its refugee capacity. UNICEF is also launching a solo campaign for children in the Horn of Africa, with a particular focus on Somalia.

The UNICEF and WHO-backed campaign in Dadaab will target 202,665 children under five years of age, with measles and polio vaccines, together with Vitamin A and de-worming tablets. The campaign is part of a regional push to ensure all children in drought affected areas are vaccinated against a killer disease like measles which can be deadly for malnourished children, and be protected from polio.

The solo UNICEF campaign for the rest of the Horn of Africa includes a strategy to vaccinate every child in Somalia under the age of 15 against measles which totals over 2.5 million children.

“This is a child survival crisis,” said Elhadj As Sy, UNICEF Regional Director for Eastern and Southern Africa. “Children don’t die just because they don’t have enough food. In various stages of malnutrition, they are more prone to sickness and disease. As big a challenge as the rates of malnutrition pose, the danger for children extends even further.”

“Malnutrition can weaken a child’s immune system, increasing their susceptibility to infectious diseases like measles and polio,” says Ibrahim Conteh, UNICEF Dadaab Emergency Coordinator. “We are acting now because these diseases can spread very quickly in overcrowded conditions like we have now in the camps.”

Measles is a highly contagious disease which can flourish in unsanitary and overcrowded environments like refugee camps. Measles reduces a child’s resistance to illness and makes them more likely to die when they are malnourished and suffering from other diseases.

Launching a vaccination campaign in the Horn of Africa is no simple task, even without a drought crisis to worry about. The region experiences atrocious coverage rates as evidenced by Southern Somalia where vaccination coverage is just 26%, one of the lowest in the world.

This suggests that there may be issues with the cold chain transportation of vaccines in the region. In the developing world, transporting vaccinations is complicated as high temperatures, scarce resources, unreliable electricity, and long distances between health care facilities can all break the chain.

Mobile vaccine refrigerator. Photo Credit: True Energy

This means that as UNICEF, WHO and the Kenyan MOH roll out of their campaigns, they must take extra precautions to make sure vaccine spoilage is minimized as much as possible. So many children’s lives depend on the vaccines being functional and on time.

Most, if not all of the vaccines being distributed in the campaigns will be transported using mobile vaccine refrigerators. There are mobile refrigerators currently in use all over the developing world that utilize innovative vaccine monitoring systems.

SmartConnect box

True Energy, a company highlighted in the past supplies a grid powered or solar powered refrigerator that offers vial vaccine monitoring to monitor the temperature of the vaccines along the cold chain. They also include a SmartConnect SMS monitoring system that sends out an SMS to the recipient alerting them of temperature changes along the cold chain for instantaneous monitoring.

PATH is one organization that has purchased these vaccine refrigerators with the SmartConnect capability. UNICEF has also commissioned these refrigerators from True Energy and is shipping the refrigerators for use in over 30 countries. Furthermore, the True Energy refrigerators meet WHO cold chain requirements.

Therefore, there should be no excuse for inadequate monitoring of vaccines amidst the vaccination campaigns. The technologies exist to ensure cold chain efficiency. Moreover, UNICEF and WHO have both recently dabbled with these existing technologies.

With reports that the drought in the Horn of Africa has not yet reached its peak, the vaccination efforts must be successful or millions of children may suffer the consequences.

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