Saptarshi Purkayastha, Director R &D, HISP India Brajesh Murari, Senior Software Developer, HISP India Technological Challenges and Approaches to Deploying Mobile Technologies for Public Health Information Systems

The Health Information Systems Programme is a global south-south- north collaborative network of researchers, governments, health-care professionals and academic institutions. Initated by and coordinated from the Global Infrastructures Research Group at Department of Informatics, the network has since 1994 been involved in many countries in "Global South". Our aim is better health care in developing countries through the combination of research on and implementation of Health Information Systems. Global Partners include Health Metrics Network, WHO, OpenMRS, Norad and many in-country partners in every implementation country.

The presentation explores significant potential of mobile in HIS  Community-based Monitoring  Reporting  Health-record information  Feedback to health-service providers  Strengthen communication between health providers and patients and community Also acknowledges many challenges as well to implement mobile technologies in resource We present:  A review of how technology was selected among already available solutions  Creating a simple technology solution  Implementing an m-Health solution not as an independent application  Feedback of health workers on using the application  Learnings from the study

Low-resources communities are not only economically poor, but generally have a huge burden of health-care provisioning Low-resource also has poorly trained health staff In technology terms, low-resource settings  Limited /Weak/Slow wireless networks  Price Sensitivity of phones  Lack of Electricity and other infrastructure  Low Technology Skills Mobile phones in these low-resource settings are:  Limited processing power  Small screen size  Limited visualization  Limited memory Clinics! Health Care Burden

Allows transmitting facility-level data for all kinds of health programs and dataset including routine, surveillance, survey data for quarterly, monthly, weekly or daily periods Works on lowest cost Java-enabled phones (Rs ) Low operating cost (3-4 SMS/month – <Rs. 10/month) Forms have pages similar to paper forms Mobile application in local language Integrated with state HMIS and reporting mechanisms ANM at Subcentre Block Computerized PHC PHC Feed-back Mobile Phone GSM Gateway SERVER GSM Gateway SERVER 1 2

Mobile phones provided by NHSRC under NRHM and SIM cards purchased by state Mobile-SCDRT was implemented in 5 blocks in 5 states of different geographies, social structures and different health indicators  Himachal Pradesh (Hamirpur Dist – Sujanpur Block)  Kerala (Trivandrum Dist - Vizhinjam CHC Area/Athiyanur Block )  Gujarat (Navsari Dist - Chikli Block)  Rajasthan (Jaipur Dist – Govindgarh Block)  Nagaland (Peren Dist – Jalukie Block) 25+ training sessions, 220+ health-staff trained Health workers trained on using mobile application by NHSRC, state and dist data managers, data managers and officers trained for analysis Refresher training after 6-months of usage to monitor and improve the application Data collection through questionnaires, interviews and official health system feedback.

QuestionResponse 1.) Did you get mobile phone with the sub-centre form?100% YES (167) 2.) Did you fill monthly report on mobile and send the SMS?100% YES (167) 3.) Is the form on the mobile phone as the one given to you? 82% YES (139) 18% NO (28) – No linelisting 4.) Were you oriented on new forms? 90% YES (151) 10% NO (16) – No training from state 5.) How did you find filling the form on the mobile phone? a)94% EASY (157) b)5% NOT EASY (8) – No localization c)1% DIFFICULT (2) – No training manual 6.) Can you fill the form on the mobile phone independently? 99% YES (165) 1% NO (2) – Retiring, Will not fill the form 7.) Do you think sending sub-centre report through mobile phone help your work? 100% YES (167) 8.) Do you think it will help to send all reports through mobile phone100% YES (167) 9.) Could you easily read the form on the mobile phone 93% YES (156) 7% NO (11) – Localization / element number 10.) How do you think mobile phone can be made more useful to youGENERAL QUESTION:

Questions are welcomed We need support from developers who understand J2ME programming to scale the implementation.  Please visit:  Or write to: or