Saving lives, changing minds. Rapid Mobile Phone-based (RAMP) survey Changing the way we collect data in Health Surveys Presented by Jenny Cervinskas and Michael Charles On behalf of the RAMP team for the Namibia rollout May 19 th, 2011 IFRC, Johannesburg

Saving lives, changing minds. Outline Purpose of the RAMP Key features of the RAMP Traditional vs. mobile phone based surveys RAMP How it works How much it costs Benefits of the tool Stakeholder benefits RAMP rollout in Namibia Future steps

Saving lives, changing minds. Purpose of the Rapid Mobile Phone-based (RAMP) survey  To provide a survey methodology in which Red Cross and Red Crescent National Societies, governments and other partners can conduct health surveys at reduced cost, with limited technical assistance, and achieve high standards of survey design and quality  To dramatically decrease the time that data is available for decision making  To use mobile phones and a web-based, freely accessible software domain as a data collection technique to conduct health surveys.

Saving lives, changing minds. Key Features of the RAMP  Allows for web based questionnaire design using EpiSurveyor  Allows for questionnaire forms to be uploaded to standard mobile phones  Allows for data collection using low cost, familiar and widely available mobile phones (e.g. Nokia, Samsung)  Has an accompanying training manual, technical manual, and tools adaptable to local settings  Data can be exported to Microsoft Excel, as a text file, and in Mdb format  Allows for rapid analysis and reporting of survey results

Saving lives, changing minds. Traditional Paper and Pencil Questionnaire The time and monetary costs of data collection can be substantially reduced if mobile phone data collection is used in place of the traditional paper and pencil method that has been the best practice in health surveys for decades

Saving lives, changing minds. With the RAMP you can transform a standard mobile phone into an innovative evaluation or research tool Conduct surveys and capture data from a standard mobile phone Manage surveys, people and data from your web-based server

Saving lives, changing minds. How does it work?

Saving lives, changing minds. Web Based Server  Create a free account using Datadyne’s EpiSurveyor software  Access your web based server from a web browser anywhere in the world  Design your questionnaire with embedded logic and in multiple languages  Monitor, manage and communicate with your team  Export data and analyze results in real- time. 

Saving lives, changing minds. Why use mobile phones to collect data?  Real-time data entry on cell phones  Daily upload of data from cell phone over 2G cell network to internet database  Real-time data monitoring and data quality checks  Real-time data cleaning  Real-time data analysis  Rapid production of survey results within hours or days of last interview

Saving lives, changing minds. Stakeholder benefits Decision Makers No software licensing or subscriptions Optimizes resource usage and reduces environmental impact Maintain data security and respondent confidentiality Scalable solution for teams and studies of varying sizes Researchers/Evaluators Incorporate a multitude of question types with custom logic and validation Manage and upload surveys in multiple languages Monitor staff work rate, productivity and quality Generate reports on responses as they arrive Export data for custom analysis with your favourite statistically analysis package Fieldworkers Conduct surveys anywhere, even in areas with no network coverage Use standard and familiar mobile Minimal training requirements No more paper to collect, transport or return Automated submission of data when network reception is available

Saving lives, changing minds. RAMP Rollout in Namibia: Focus on Malaria

Saving lives, changing minds. Partners  Namibia Red Cross Society  IFRC  MOHSS  Namibia Bureau of Statistics  Datadyne

RAMP survey site: Caprivi region, Namibia

Saving lives, changing minds. Malaria is a major public health problem in Caprivi

Saving lives, changing minds.  Caprivi region (north eastern Namibia)  Recently launched NRC project on Communities Fighting Malaria  RAMP carried out in four of the five constituencies in the project  RAMP malaria indicators survey provides a baseline for some of the project’s key indicators  Mobile network coverage (MTC provider) Site and project identification

Saving lives, changing minds.  Standard survey methodology used in an RAMP survey  1 st stage: standard probability-proportional-to- estimated-size (PPES) selection of clusters  Sampling frame: PSUs from the 2001 national population census, and 10 camps of people resettled due to flooding of the Zambezi river  2 nd stage: selection of households- simple random sampling (SRS) to choose 10 households/cluster Survey methods

300 Households 30 clusters, 10 households/cluster, total of 300 households in the survey sample

Saving lives, changing minds.  Modeled after the standardized MIS questionnaires  Household questionnaire  Person roster/Treatment and diagnosis of fever in U- 5S  Net roster ◦ Types of bednets; source of nets; age of nets; who slept under each net; number of people that slept under each net  Questionnaire administered in Silosi Survey questionnaires

Saving lives, changing minds.  NRC volunteers that serve as supervisors in the CFM project (interviewers)  NRC volunteers that serve as supervisors in another project (field supervisors)  Training – 5 days (May 2-6, 2011) in Katima Mulilo Recruitment of surveyors

Training Adapted the RAMP curriculum and guide  Content  Cellphone basics  Questionnaires  Informed consent  Interview techniques  Field procedures  Field logistics/reporting  Supervisor training  Methods  Presentations, role play, group discussion, demonstrations, field tests (2), energizers

Six teams- two interviewers per team Three field supervisors +Survey Supervisory Support Team

Fieldwork Locating the households Household interview May 2-6, 2011

Real- time data editing and cleaning Data is monitored remotely Daily data editing and cleaning

Survey Team Debriefing: 1 day after last interviews Presentation and discussion of preliminary results

Award of certificates “I feel happy knowing how to collect data with the cellphone” Organizers happy the survey was completed successfully

Saving lives, changing minds.  Take time to prepare cellphones prior to the survey  Establish strong working partnership  Criterion for selection of survey teams needs to be clear, and adhered to for recruitment  Data entry: worked well, all teams were able to collect data using the cellphone and send to server  Red Cross volunteers with secondary school education can collect data in the field  Survey conducted with reasonable adherence to correct field procedures; need to further refine some methods and tools Lessons learned

Saving lives, changing minds. Preliminary Results

Saving lives, changing minds. Survey results bulletin & report Survey Report

Saving lives, changing minds. Results: key indicators, HH questionnaire

Saving lives, changing minds. Access: Just 52% of ITNs needed to reach universal coverage are present. Gap is 48%. Key indicators Target population47,932 Persons per net2.13 ITNs needed Survey-estimated ITNs in HH of target pop (52%) ITN/LLIN need/gap (48%)

Saving lives, changing minds. Results: High percentage of ITNs are being used. Use gap is due to insufficient ownership of ITNs Key indicatorsPoint estimate % ITNs that were slept under last night86% % ITNs that were hung last night82% ITN use, all ages38% ITN use, <5 yo42%

Saving lives, changing minds. ITN use by age group

Saving lives, changing minds. Age in months % <12 months months months3 36+ months36 Age of ITNs * 87% of nets were LLINs

Saving lives, changing minds. Number of persons sleeping under ITN last night%, nets 1 person30 2 persons42 3 persons18 4 persons10 Number of persons under a ITN last night

Saving lives, changing minds. Treatment & diagnosis, <5 yo Key indicators% Treated ACT, <5 yo71 Treated ACT within 24 hours, <5 yo61 Received finger/heal stick for blood31 - Denominator for all indicators was % of children <5y with fever in the previous two weeks

Saving lives, changing minds. Cost componentUSD Training11,498 (32%) Survey operations: personnel10,515 (29%) Survey operations: transportation10,993 (30%) Cell phones2,788 (8%) Other749 (2%) Total36,449 How much does the RAMP cost?

Saving lives, changing minds. So, does the RAMP “work”?  Conducted by secondary-school graduates with no previous survey experience  Survey was completed within two weeks  5 days training, 5 days field work  Daily data cleaning accomplished  Preliminary survey results bulletin finished within 24 hours  Preliminary report finished within 72 hours  Provided excellent management information on the key indicators

Saving lives, changing minds. Cellphone-based Surveys: Summary Points REAL-TIME DATA AVAILABILITY AND ANALYSIS  Via your web-based server, responses may be viewed, monitored and exported instantly IMPROVED DATA INTEGRITY  The removal of paper from the research process reduces the number of points at which error can be introduced FIELDWORKER MONITORING/MANAGEMENT  Monitor the productivity and quality of research conducted by field staff (GPS, time and date stamp) ENHANCED MOBILITY  Do not need network coverage to conduct surveys, responses are stored securely on the mobile phone, thus can reach even the most remote communities OPTIMISED RESOURCE USAGE  Save on survey printing, distribution and collection costs

Saving lives, changing minds. What’s next?  Extract lessons learned from Namibia and apply in next survey  Implement RAMP in one other country (Cross River State, Nigeria in June 2011)  Finalize and disseminate the RAMP technical manual and the training manual  Continue developing training manuals and strategies for technical support in order to gradually reduce external support  Test the RAMP in other sectors and disciplines if appropriate  Continue searching for innovative ways to collect data in a timely fashion in order to better serve the communities we work in

Saving lives, changing minds. Mobile Phone Application  Install this tiny Java application onto a standard mobile phone  Login to EpiSurveyor using your user name & password and download form  Capture data in the field, even without network coverage  Enter data using the interface of the mobile phone.  Transforms complex logic into an effortless step-by-step process.  Automated submission of data when 2G reception is available.

Saving lives, changing minds. Thank you Any questions?

Saving lives, changing minds. Extra Photos & Information

49% of households are headed by women

Saving lives, changing minds.  Morning briefing (“quality round”)  Locating the chosen cluster and selecting the households to be interviewed  Conduct interviews at HH level  Supervisor sends data to server  Data cleaning and analysis A day’s schedule