““Improving Community Reach through Mobile Technologies: The PCI experience” ” Kwaku Yeboah, MB,CHB,MPH Vice President, HIV/AIDS Programs. PCI July 25, 2012

Our Mission is to prevent disease, improve community health and promote sustainable development. PCI’s Reason for Being Our Vision Motivated by our concern for the world’s most vulnerable children, families and communities, PCI envisions a world where abundant resources are shared, communities are able to provide for the health and well-being of their members, and children and families can achieve lives of hope, good health and self-sufficiency.

Our Global Impact

Introduction M-health a subset of e-health (use of ICT) Increasingly used globally including developing countries Used in –collecting community and clinical heath data –Delivery of health care information to practitioners, researchers and patients –Real time monitoring of patients –Direct provision of care via telemedicine Based on high mobile telephony and mobile application access –It is projected that India will have billion mobile subscribers by 2013 –More than 735 million subscribers estimated by 2012 in Africa.

M-Health in PCI Currently used in programs in –India –South Africa –Zambia –Guatemala * *not quite functional yet.

M-health in India Recent/Current usage in –Providing prenatal, post natal immunization information in Sure Start Project –Provide counseling and messaging on ART adherence in PATHWAY Project –Key awareness on polio immunization –Support Microfinance Institution (MFIs)

How This Has Been Done Polio immunization program Community HIV Care and Support Program Using mobile SMS, alerts and networks Microfinance institutions Immunization information Developing customized mobile application

Networking With Free SMS Services – Polio Immunization Program Networking with a local (Moradabad) News channel, that send SMS messages each time to approx 25,000 persons PCI provides “SMS text content” to the news channel The message is delivered before and during polio rounds to influencers, resistant families, government officials

DEVELOPING CUSTOMIZED MOBILE APPLICATION

Process Understand the need and what we want to do Understand the “mobile” behavior of the communities Develop mobile application Partner with the mobile operators Community launch- training

Understanding “Mobile” Challenges Who controls the handset –women clients may not fully control the mobile handsets Training or skill building needs –A survey reflected 71% of clients felt they would need “handholding” in use of mobile handsets Literacy could be an issue Affordability –charges will need to be passed to sender rather than recipient Mobile technology –In one of the PCI project areas- 63% population are using GSM vs. 37% using CDMA

Outcomes Sure Start: –Improvements in early antenatal registration ( %), 4 antenatal check ups ( %) institutional delivery ( %) and thermal care ( %) between 2008 and 2011

Outcomes -2 Polio Program: –Improvements in uptake of polio vaccinations PATHWAY: –Improvements in ART adherence (98% vs 78% nationally, 2010)

M-Health in South Africa Prevention in Action –A four year program focused on preventing violence against women (VAW) as an HIV prevention strategy implemented by PCI (SA), KwaZulu-Natal and Western Cape Networks on VAW –A cellphone-based SMS system was used to encourage reporting of actions –actions being documented into a “SalesForce” monitoring system via call-backs

M-Health in South Africa - 2 –Actions were ‘amplified’ through ongoing documentation on video, in graphic formats, via events, via facebook SMS, and through news media

M-health in South Africa – Analysis of Reported Actions in PIA

Outcomes: South Africa VAW is being addressed through collective community action which has led to –Reduced partner violence –Improved conflict resolution etc.

M-Health in Zambia Cervical cancer screening in mobile HTC –Digital photos of cervical lesions taken –Photos sent by wireless to gynecologists off site for consultation –Prompt feedback from gynecologist to confirm diagnosis and offer appropriate treatment; 72/108 eligible clients offered on site treatment –SMS messaging to remind clients about review dates and follow up with gynecologists for clients referred Led to high referral completion 34/36 (94.4%)

M-health in Zambia

Conclusion Improved access to mobile telephony and mobile application access provides excellent opportunities to improve community reach and improve public health outcomes Fast pace in m-health evolution may not allow for experience sharing Community involvement in design of applications crucial in making them relevant Additional untapped opportunities exist that can be further explored and utilized Effective partnerships are crucial for M-health