Enhancing Community Health Workers Performance With Mobile Technology Dennis M. Israelski, MD President and CEO, InSTEDD with support from PEPfAR,HIPPP

Source: Wall Street, 20th Century Fox, Written by Stanley Weiser and Oliver Stone, Directed by Oliver Stone, Produced by Edward Pressman, 1987

Global Cell Phone Usage Over Under.300 Cell Phones Per Person source: World Bank,

Over Under % of the global population is a mobile phone user Cell Phones Per Person source: World Bank,

source: CIA World Fact book billion users in the developing world 87% of the global population is a mobile phone user

Ray Kurswell quote: kid in africa has more info than the pres 15 yrs ago A kid in Africa with a smartphone today has access to more information than the President of the United States had just 15 years ago. source: Quote from Futurist, Ray Kurzweil, Time Magazine, March 26, 2012

small lightweight portable connected inexpensive simple convenient intuitive accessible + opportunity

community CHW performance formal health system The Community Health Worker at the Intersection of Two Dynamic Systems source: USAID Community Health Worker Evidence Summit Concept Note, 2012

countries have severe shortages of health workers 57

are in sub- Saharan Africa 36

Countries with a Critical Shortage of Health Service Providers (doctors, nurses and midwives) countries with critical shortagecountries without critical shortage source: WHO, Global Atlas of Health Workforce (

53% of the population of Africa owns a mobile phone source: World Bank, 2011

74% of the population of Asia owns a mobile phone 53% of the population of Africa owns a mobile phone source: World Bank, 2011

mobile communications technologies mHealth + health issues + service delivery + decision support + supervision + more mHealth: at the intersection of mobile communication technologies and health

mHealth: the delivery of health care services via mobile communication devices

initial search strategy n = 5,868 unique citations n = 4,667 relevant mHealth literature obtained n = 2,603 relevant CHW & mHealth literature obtained n = 35 full text of potentially relevant literature obtained n = 37 literature included in analysis n = 26 duplicate citations identified & excluded n = 1,201 mHealth exclusions based on title, abstract & author key words n = 2,064 CHW exclusions based on title, abstract & key words n = 2,568 CHW & mHealth inclusions based on citations n = 4 studies excused post full-text review n = 11 Systematic Review of the Literature Catalani, C et. al. ( Manuscript in Preparation) supported by HIPPP, PEPfAR

engineeringmedical public health global developmen t databases mHealth research areas Catalani, C et. al.

Systematic Review of the Literature Catalani, C et. al. ( Manuscript Submitted) supported by HIPPP, PEPfAR

Systematic Review of the Literature Catalani, C et. al. ( Manuscript Submitted) supported by HIPPP, PEPfAR

- errors - data loss - lack of real-time QA - lack of CHW supervision - lack of rapid response - travel expenses Mahmud N, Rodriguez J, Nesbit J. A text message-based intervention to bridge the healthcare communication gap in the rural developing world. Technology and health care: official journal of the European Society for Engineering and Medicine Jan;18(2): Curioso WH, Karras BT, Campos PE, Buendia C, Holmes KK, Kimball AM. Design and implementation of Cell-PREVEN: a real-time surveillance system for adverse events using cell phones in Peru. AMIA... Annual Symposium proceedings / AMIA Symposium. AMIA Symposium Jan;: Bernabe-Ortiz A, Curioso WH, Gonzales MA, Evangelista W, Castagnetto JM, Carcamo CP, et al. Handheld computers for self-administered sensitive data collection: a comparative study in Peru. BMC medical informatics and decision making Jan;8:11. Tomlinson M, Solomon W, Singh Y, Doherty T, Chopra M, Ijumba P, et al. The use of mobile phones as a data collection tool: a report from a household survey in South Africa. BMC medical informatics and decision making Jan;9:51.

Asia N=5 Africa N=9 North America N=1 South America N=2 mHealth research locations Catalani, C et. al.

mHealth research use cases provide decentralize d services address health issues professional support & supervision provision of medical services Catalani, C et. al.

mHealth effective support for task shifting + health system productivity + human resources - errors- costs Catalani, C et. al.

+ fewer errors + less data loss + real-time review of quality + close CHW supervision + rapid response capabilities + cost effective Mahmud N, Rodriguez J, Nesbit J. A text message-based intervention to bridge the healthcare communication gap in the rural developing world. Technology and health care: official journal of the European Society for Engineering and Medicine Jan;18(2): Curioso WH, Karras BT, Campos PE, Buendia C, Holmes KK, Kimball AM. Design and implementation of Cell-PREVEN: a real-time surveillance system for adverse events using cell phones in Peru. AMIA... Annual Symposium proceedings / AMIA Symposium. AMIA Symposium Jan;: Bernabe-Ortiz A, Curioso WH, Gonzales MA, Evangelista W, Castagnetto JM, Carcamo CP, et al. Handheld computers for self-administered sensitive data collection: a comparative study in Peru. BMC medical informatics and decision making Jan;8:11. Tomlinson M, Solomon W, Singh Y, Doherty T, Chopra M, Ijumba P, et al. The use of mobile phones as a data collection tool: a report from a household survey in South Africa. BMC medical informatics and decision making Jan;9:51.

small scale independent exploratory non- collaborative project E project C project G project B project H project F project D project A

small scale independent exploratory non- collaborative project E project C project G project B project H project F project D project A PILOTITIS

interoperability reusability scalability sustainability project C project G project B project H project F project D project E project A

+ country leadership & ownership* + human-centered design + engaged end users + capacity development* + strategic reuse* + interoperability + open source accessibility* + coordinating, harmonizing & sharing* + research & evaluation* + implementation science agenda for M&E, operations research, economic assessment & impact evaluation Recommendations for the Future *Greentree Principles

Caricia Catalani, DrPH, MPH InSTEDD and University of California, Berkeley* Rebecca Braun, DrPH(c), MPH University of California, Berkeley Enhancing Community Health Workers Performance With Mobile Technology (manuscript in preparation)

*former member Health Informatics, Public Private Partnership A Central OGAC Initiative Paul Biondich, Regenstrief Institute Dennis Israelski, InSTEDD Chris Seebregts, Jembi, South Africa Mike Gehron, OGAC John Novak, USAID Xen Santas, CDC Chris Bailey, WHO* Management Team