MOTECH Ghana & MOTECH Platform Lessons Learned, Current Work & Future Plans

Grameen Foundation Mission: To alleviate poverty for the poorest of the poor Increasingly, this means alleviating information poverty GF Technology Center in Seattle is focused on health and agriculture domains Mix of enabling technology and on the ground interventions

MOTECH Ghana Partnership with Ghana Health Services, Gates Foundation, and Columbia University Original goal: Use technology to improve health outcomes

Narrowing the Focus Government Ghana Health Services Goals Clients Pregnancy Question Box Pregnancy Diaries Focus Groups Nurses Focus Groups

Ghana Health Service Focus on Maternal & Child Health -Antenatal visits -Vaccinations -Attended Delivery Improve Reporting Target Upper East Region

Upper East Region Population: 1M Infant Mortality Rate: 97/1000

Client Research

Pregnancy Question Box

Focus Groups

Nurse Research

Reducing Information Poverty Clients Actionable health advice Facts to dispel myths & folklore Information to encourage family support Recommend specific care Nurses Electronic records Patient status alerts Government Ability to flexibly analyze reliable data

Mobile Midwife Service Messaging service coordinated with a woman’s pregnancy Covers early pregnancy to baby’s first year Aimed at the mother and her extended community Delivered via pre-recorded voice or text message up to three times per week Customized for the mother Available when she wants the information Educational and actionable information

Audio Samples Week 5: Food for pregnancy Week 24: 2 nd checkup, SP for malaria Week 34: Signs of labor Local language Intro prompt Tetanus reminder Missed tetanus vaccination

Audio Samples Week 5: Food for pregnancy Week 24: 2 nd checkup, SP for malaria Week 34: Signs of labor Local language Intro prompt Tetanus reminder Missed tetanus vaccination

Audio Samples Week 5: Food for pregnancy Week 24: 2 nd checkup, SP for malaria Week 34: Signs of labor Local language Intro prompt Tetanus reminder Missed tetanus vaccination

Audio Samples Week 5: Food for pregnancy Week 24: 2 nd checkup, SP for malaria Week 34: Signs of labor Local language Intro prompt Tetanus reminder Missed tetanus vaccination

Audio Samples Week 5: Food for pregnancy Week 24: 2 nd checkup, SP for malaria Week 34: Signs of labor Local language Intro prompt Tetanus reminder Missed tetanus vaccination

Audio Samples Week 5: Food for pregnancy Week 24: 2 nd checkup, SP for malaria Week 34: Signs of labor Local language Intro prompt Tetanus reminder Missed tetanus vaccination

Audio Samples Week 5: Food for pregnancy Week 24: 2 nd checkup, SP for malaria Week 34: Signs of labor Local language Intro prompt Tetanus reminder Missed tetanus vaccination

Audio Samples Week 5: Food for pregnancy Week 24: 2 nd checkup, SP for malaria Week 34: Signs of labor Local language Intro prompt Tetanus reminder Missed tetanus vaccination

Nurse Application Records patient visits using mobile forms or SMS Reminds nurse of upcoming and overdue patient needs Generates monthly reports Query the system to get information about patients

Hey, this might be useful… Build a Platform for mobile health applications Open Source Funded through implementations and platform-specific grants

How is MOTECH Ghana Doing? Registrants: 13, 598 Mobile Midwife enrollees: 7, 395 (3,950 active) Health Facilities: 34 Nurses: 110 Encounter uploads: 75,000

How is MOTECH Ghana Doing? “I liked the messages especially on the nutrition as I was able to share with my husband so he could hear it and now I am allowed to get these things such as beans, vegetables, small ground fish for the soup and sometimes meat” “Now with MOTECH I don’t feel alone during my pregnancy, it makes me feel that there are people that care for me and are concerned about me while I am pregnant. ” “MOTECH helps a lot with the preparation for birth and I felt like I had a good idea of what would happen and how to prepare practically and financially. I went to Paga Health facility and had a safe delivery. ”

How is MOTECH Ghana Doing? “This is the age where we transmit data which is efficiently collected and accurate for managers to make informed decisions at district, regional and national levels. That is what MOTECH is all about” Dr Nyonator, PPME Director, GHS “When patients receive those messages they come here [to the clinic] early and on time so when they come we look at the services they are due for and we render those services to them and because of that the defaulters that we used to have previously has been reduced.” CHPS Nurse “Some months ago I used to get two or three, but last month I had ten deliveries [at the facility] because the clients get the messages and they come. For postnatal they come. Even if they deliver at home they get the messages [from MOTECH] which make them come for postnatal. So I have benefited from MOTECH a lot.” GHS Midwife

What we’ve learned in Ghana Technology IS disruptive Mobile penetration is high, access not so much Design for scale Voice trumps text – but higher cost mandates strong business model Iterate, Iterate, Iterate (e.g. getting voice and content right) Lessons learned document: ( default/files/MOTECH-Early-Lessons- Learned-March-2011-FINAL.pdf) default/files/MOTECH-Early-Lessons- Learned-March-2011-FINAL.pdf

What’s next for MOTECH Ghana Two year plan to expand to three new districts Immediate plan to explore long-term business models Launching impact assessment program Transition to scale –Ghana Health Service ownership of key services –Infrastructure to support national deployment

What’s next for the Platform

Partnering MOTECH’s strength Rules-based Messaging Pill & Appointment Reminders Message campaigns Connecting disparate health system components

Platform Components Today MOTECH (Grameen) Patient DB IVR EngineRules EngineNurse DB IVR & SMS ContentAlert/Reminder Engine Connections to external systems CommCare (Dimagi) Point of Care ToolsSupervisory ToolsData Entry Forms Video Training Content Nuntium & Verboise (InSTEDD) IVR and SMS Integration with Telcos

2012 Platform Implementations Ghana Treatment Advice for Mobile Alerts (TAMA) –HIV/ART compliance Bihar, India –CARE  Mobile messaging –BBC World Service Trust –World Health Partners  TB diagnosis and treament adherence Zambia / World Vision –Referrals, Patient outreach

Questions?