1. mHealth Field Guide for Newborn Health CORE Group Presentation to the mHealth Working Group Kelly Keisling, CORE Group mHealth Interest Group January 28 th, 2014

2. CORE Group Background Improve and expand community-focused public health practices for underserved populations around the world Generate collaborative action and learning with 70+ Member and Associate organizations and partner network Emphasis on women of reproductive age and children under five Collaborating partner organization with the Maternal Child Health Integrated Program (MCHIP)

3. CORE Group mHealth Interest Group Organized grants contest to support mHealth pilots for community health, in collaboration with Dimagi under NORAD IWG Supported Learning Collaborative among mHealth grants winners Coordinated with mHealth Working Group to co-host Deep Dive meetings at CORE Group 2013 spring and fall annual meetings Hosted mHealth sessions at 2013 spring and fall annual meetings

4. mHealth for Newborn Health mHealth can support integration of care across continuum of reproductive, maternal health, newborn and child health (RMNCH) Leveraging Mobile Technologies for Maternal, Newborn & Child Health (mHealth Alliance) Leveraging Mobile Technologies for Maternal, Newborn & Child Health mHealth and ICT Framework for RMNCH (Labrique et al) mHealth and ICT Framework for RMNCH mHealth, eHealth, Reproductive Health (PATH) mHealth, eHealth, Reproductive Health Early concentration of risk calls for emphasizing delivery of quality care at the time of birth and weeks after birth Mobile Tools for Health Workers Targeting Neonatal Health in Low-Resource Settings (Maria Freytsis of Maternity Neighborhood to mHealth Working Group Dec. 2013) Mobile Tools for Health Workers Targeting Neonatal Health in Low-Resource Settings

5. Bridge Gaps in mHealth Capacity Awareness Knowledge Decision- Making HQ level Field Projects

6. Making mHealth Relevant to Implementation Awareness Knowledge Decision- Making Practical guidance that supports decision making Relevant to field project outcomes Field Projects

7. Primary audience: field staff Secondary: donors, ministries, HQ How mHealth serves newborn health Introduce and frame information resources Frame implementation issues Cases illustrate practical information: Newborn health problem statement Development process Project management/staffing/partnerships Costs Results Next steps for scale up

8. Cross-Regional and Cross-Organizational Perspective Case Studies from Various Countries Afghanistan India Indonesia Malawi Review Committee Catholic Relief Services CORE Group PCI Global Save the Children World Vision

9. Newborn Health Interventions High-impact, simple interventions for newborn lives in maternal child care continuum 1 Immediate focus on newborn health 1. The Lancet. The Executive Summary of the Lancet Neonatal Survival Series. http://www.who.int/maternal_child_adolescent/documents/pdfs/lancet_neon atal_survival_exec_sum.pdf. Accessed Nov. 18, 2013.Nov. 2013.

10. mHealth for Newborn Health Interventions Clinical Care Outreach Services Level of Care Ways to Strengthen Care Family/Community Referral and Tracking Decision Support for CHW CHW Supervision Scheduling & Tracking Follow Up Visits Teach & Counsel Mother and Family

11. Case Studies to Illustrate Use Cases Type of mHealthCase Study Referral and Tracking - Better Health for Afghan Mothers and Children - Reducing Maternal and Newborn Deaths - SIJARIEMAS Referral Exchange System - Chipatala cha pa Foni Decision Support - Better Health for Afghan Mothers and Children - Reducing Maternal and Newborn Deaths CHW Supervision - Better Health for Afghan Mothers and Children - Reducing Maternal and Newborn Deaths Scheduling and Tracking Follow Up Visits - SIJARIEMAS Referral Exchange System - Reducing Maternal and Newborn Deaths Teach and Counsel Mother and Family- Reducing Maternal and Newborn Deaths - Chipatala cha pa Foni - SIJARIEMAS Referral Exchange System

12. Better Health for Afghan Mothers and Children Country: Afghanistan Implementers: World Vision and Dimagi mHealth Types: Referral and Tracking, Decision Support, CHW Supervision Results:Changes in 7 health related behaviors: - Development of birth antenatal care visit - Planning for transportation - Coordination with health facilities - Knowledge of danger signs during pregnancy - Institutional deliveries amongst women - Early initiation of breastfeeding

13. Reducing Maternal and Newborn Deaths Country: India Implementers: Catholic Relief Service, Dimagi and Vatsalya mHealth Types: Decision Support, Teach and Counsel Mother and Family, CHW Supervision, Referral and Tracking Scheduling and Tracking Follow Up Visits Develop. Process: Testing with illiterate ASHA (CHW) led to development of audio and visual formats Partnership: Technical backstopping by IT partner enabled CRS development of supervisor app & IT troubleshooting

14. Chipatala cha pa Foni Country: Malawi Implementers: VillageReach, Concern Worldwide and partners mHealth Type: Teach and Counsel Mother and Family Partnership:Collaboration with local developer of electronic medical records prevents duplication of records Project Mgmt:Real-time monitoring reveals missed calls due to understaffing, prompting adjusted staffing plan

15. Sistem Informasi Jejaring Rujukan Maternal & Neonatal Referral Exchange System Country: Indonesia Implementers: RTI with EMAS partners (Jhpiego, Budi Kemuliaan Hospital, Muhammadiyah, Save the Children) mHealth Types: Referral and Tracking, Teach and Counsel Mother and Family, Scheduling/Tracking Follow Up Visits Costs:- Software development under $10,000 due to local developers & open source software - Training, mentoring and hardware are high costs - Implementation & operating costs higher than development, but shared with stakeholders to encourage ownership.

16. Framing Implementation Issues and Lessons Learned Quality of design: Results varied for modules with more time and refinement. Sufficient time, budgeting and design methods are required. Narrow technological approach to ICT: Testing with illiterate CHW required redevelopment for audio/visual formats. Understand the needs of users and beneficiaries. Changes in communication patterns: CHW may prefer calls or find SMS less intimidating. Fit users communication patterns and preferences. Changes in the power structure: Male CHW provide social permission for female CHW to use phone publically. Gender can influence project design. Demand: Community volunteers introduce mHealth, but lose enthusiasm. Robust demand generation can support adoption by users and gatekeepers.

17. Framing Implementation Issues and Lessons Learned Modifications to planned implementation: Modification of complex modules takes significant time. Begin with simple features. Project planning and management: Unrealistic time expectations resulted in design limitations. Sufficient time, staffing and supervision are required. Costs: Reduced costs from reused components, open source, shared equipment costs. Costs vary but various strategies are available for reducing or sharing costs. Organizational capacity: Projects lack sufficient capacity or staff. Trainings, guides and technical assistance can address challenges. Government commitment and capacity: Difficulty finding right counterpart. Align with government goals and expectations. Partnerships: Pilot development and national coverage involve different capacities. Scale up can shift responsibilities to new partners.

18. Potential Next Steps Dissemination and outreach to newborn health projects Use of guide in mHealth workshops Adapt guide into training curriculum Provision of newborn health use cases to developers, hackathon Field testing of guide Use of guide in design stage of newborn health project Interest in potential partners

19. Questions, Comments, Interest in Follow Up For further information: contact@coregroupdc.org mHealth Field Guide for Newborn Health available: http://www.coregroup.org/storage/mHealth_Guide_for_Newborn_Health.pdf