Saving lives, changing minds. Management Survey Tool Changing the way we collect data in health surveys Presented by Jenny Cervinskas and Bong Duke On behalf of the MST team for the Cross River State, Nigeria rollout July 6, 2011

Saving lives, changing minds. Partners  Roll Back Malaria (RBM)/MOH  Nigerian Red Cross National Society  IFRC (International Federation of Red Cross Red Crescent Societies)  WHO

Saving lives, changing minds. Outline ① MST Purpose and key features How it works How much it costs Benefits of the tool  MST rollout in Cross River State ③ What’s next?

Saving lives, changing minds. Purpose of the Management Survey Tool (MST)  Provide a survey methodology in which Red Cross societies, government and other partners can:  conduct health surveys at reduced cost  with limited external technical assistance  achieve high standards of survey design and quality  MST aims to simplify and improve the timeliness of the entire data collection cycle  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. Rapid spread & technology of cellphones opens up new possibilities What can you do with a phone? The same things you can do with any other computer. Count Talk Reward Photograph Assist Teach MonitorAnalyse

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

Saving lives, changing minds. With the MST 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?

Data is entered and saved in cellphone, sent to the server…

There is 2G/GPRS coverage in almost all villages in CRS

Survey Bulletin within 24 hours Survey Report within 72 hours

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 Reduces environmental impact Scalable solution for teams and studies of varying sizes Get data and information rapidly for decision-making and planning Evaluators/Researchers 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 Export data for custom analysis with your favourite statistical analysis package Fieldworkers Conduct surveys anywhere, even in areas with no network coverage Use standard and familiar mobile phone No more paper to collect, transport or return Automated submission of data when network reception is available

Saving lives, changing minds. MST Rollout in Cross River State, Nigeria: Focus on Malaria

Saving lives, changing minds. Site identification  Cross River State, Nigeria  10 of 18 LGAs in CRS  LLIN distribution took place January-June 2011  MST malaria survey to provide a post-campaign evaluation of the NRC door-to-door LLIN distribution and hang-up campaign  Mobile network coverage

Data collected on key indicators MST survey focus: Malaria

A rainy season survey

Saving lives, changing minds.  Standard survey methodology used in an MST survey  Multi-stage cluster sampling  1 st stage: standard probability-proportional-to- estimated-size (PPES) selection of clusters  2 nd stage: selection of households- simple random sampling (SRS) to choose 10 households/cluster Survey methods: Sampling

30 clusters, 10 households per cluster 300 households

Saving lives, changing minds.  Modeled after the standardized MIS questionnaires  Household questionnaire  Person roster/Treatment and diagnosis of fever in under-5S  Net roster  Questionnaire administered in English Survey questionnaires

Six teams: Two interviewers per team Six team leaders +Survey Supervisory Support Team

Training (June 20-24) Adapted the MST curriculum and guide  Content  Cellphone basics  Questionnaires  Informed consent  Interview techniques  Field procedures  Field logistics/reporting  Supervisor training  Methods

Fieldwork (June 27-July1)

Saving lives, changing minds.  Locating the chosen cluster, preparing the sketch map, segmentation and selecting the households to be interviewed  Conduct household interviews  Team leader/interviewers send data to server  Evening briefing (“quality round”)  Data cleaning, editing and analysis A day’s schedule

Real- time data editing and cleaning Daily data monitoring, editing and cleaning

Saving lives, changing minds. Preliminary Results

Saving lives, changing minds. Results: key indicators

Saving lives, changing minds. Other indicators Key indicators Target population Persons per net1.94 Estimated LLINs in households in all 10 LGAs Estimated LLINs in all 10 LGAs from 2011 campaign

Saving lives, changing minds. Results: High percentage of ITNs were used last night. High ITN use, especially in children Key indicatorsPoint estimate % ITNs that were slept under last night84% % ITNs that were hung last night86% ITN use, all ages60% ITN use, <5 yo71% * 99% of nets were ITNs & 99% of ITNs were LLINs

Saving lives, changing minds. ITN use by age group by gender

Saving lives, changing minds. Age in months% <12 months months months5 36+ months9 Age of ITNs

Saving lives, changing minds. Number of persons sleeping under ITN last night%, nets 1 person33 2 persons45 3 persons18 4 persons3 Number of persons under an ITN last night

Saving lives, changing minds. Treatment & diagnosis, <5 yo Key indicators% Treated ACT60 Treated ACT within 24 hours24 Received finger/heal stick for blood16 - Denominator for all indicators was % of children <5y with fever in the previous two weeks

Saving lives, changing minds. So, does the MST “work”?  Field methods followed  Daily data monitoring and 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. Cost componentUSD Training9,053 (26%) Survey operations: per diem, accommodation, technical assistance 13,604 (38%) Transportation9,698 (27%) Cellphones and equipment2,357 (7%) Other728 (2%) Total35,440 Local survey costs: CRS, Nigeria

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 work 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? For IFRC…  Extract lessons learned from Kenya, Namibia and Nigeria and share for application in other surveys  Finalize and disseminate the IFRC MST technical manual and the training manual  Continue developing strategies for technical support in order to gradually reduce external support  Test the MST 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. What’s next?