1. www.ifrc.org Saving lives, changing minds. Rapid Mobile Phone- based survey Tool Changing the way we collect data in health surveys Presented by Jenny Cervinskas and Bong Duke On behalf of the RAMP team for the Cross River State, Nigeria rollout July 5, 2011

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

3. www.ifrc.org Saving lives, changing minds. Purpose of the Rapid Mobile Phone-based (RAMP) survey  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 external technical assistance  and achieve high standards of survey design and quality  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

4. www.ifrc.org 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

5. www.ifrc.org 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

6. www.ifrc.org 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

7. www.ifrc.org Saving lives, changing minds. How does it work?

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

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

10. Survey Bulletin within 24 hours Survey Report within 72 hours

11. www.ifrc.org 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.  http://www.episurveyor.org/user/index http://www.episurveyor.org/user/index

12. www.ifrc.org 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

13. www.ifrc.org 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 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 No more paper to collect, transport or return Automated submission of data when network reception is available

14. www.ifrc.org Saving lives, changing minds. RAMP Rollout in Cross River State, Nigeria: Focus on Malaria

15. www.ifrc.org 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

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

19. www.ifrc.org Saving lives, changing minds.  Standard survey methodology used in an RAMP survey  Multi-stage cluster sampling  1 st stage: standard probability-proportional-to- estimated-size (PPES) selection of clusters  Sampling frame: population of the 10 LGAs where the door-to- door distribution took place  30 wards selected, then 30 settlements per ward, then 30 villages per each selected settlement  2 nd stage: selection of households- simple random sampling (SRS) to choose 10 households/cluster Survey methods: Sampling

20. 30 clusters, 10 households per cluster 300 households

21. www.ifrc.org Saving lives, changing minds.  Modeled after the standardized MIS questionnaires  Household questionnaire  Person roster/Treatment and diagnosis of fever in under-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 English Survey questionnaires

22. www.ifrc.org Saving lives, changing minds.  Selection panel established  Surveyors recruited from pool of NRC volunteers and RBM focal persons that served as supervisors or volunteers in the 2011 door-to-door campaign  To serve either as interviewers or team leaders  Training: 5 days (June 20-24, 2011) Recruitment of surveyors

23. 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)

24. A mix of training methods Presentation and display of antimalarial drugs Role plays

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

26. Fieldwork Sketch mapping of cluster Creating and selecting segments for HH interviews June 27-July 1, 2011

27. www.ifrc.org 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

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

29. www.ifrc.org Saving lives, changing minds. Preliminary Results

30. www.ifrc.org Saving lives, changing minds. Results: key indicators

31. www.ifrc.org Saving lives, changing minds. Other indicators Key indicators Target population1.699.246 Persons per net1.94 Estimated LLINs in households in all 10 LGAs 627.887 Estimated LLINs in all 10 LGAs from 2011 campaign 540.068

32. www.ifrc.org 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

33. www.ifrc.org Saving lives, changing minds. ITN use by age group by gender

34. www.ifrc.org Saving lives, changing minds. Age in months% <12 months85 12-23 months1 24-36 months5 36+ months9 Age of ITNs

35. www.ifrc.org 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

36. www.ifrc.org 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

37. www.ifrc.org Saving lives, changing minds. So, does the RAMP “work”?  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

38. www.ifrc.org 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

39. www.ifrc.org 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

40. www.ifrc.org Saving lives, changing minds. What’s next? For IFRC…  Extract lessons learned from Nigeria and share for application in other surveys  Finalize and disseminate the IFRC RAMP technical manual and the training manual  Continue developing 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

42. www.ifrc.org Saving lives, changing minds. What’s next?