1. MOBILE TECHNOLOGY FOR COMMUNITY HEALTH GHANA

2. Using mobile phones to increase the quantity and quality of maternal and child health services in Ghana Focus on frontline community health facilities (CHPS zone, Health Centre's) and poor women in rural areas What is MOTECH?

3. In Communities Myths & Traditional Practices The evil eye At birth hot compresses may be applied to a baby’s skull to deliberately mold the baby’s skull to give them a ‘special’ shape Colostrum is dirty Eating eggs or meat during pregnancy will make the child a thief Giving the “welcome drink” to introduce baby to the world Eating clay helps with morning sickness Knowledge Gaps Dietary requirements Health-seeking and sanitation practices for pregnant women and children Maternal & Child Healthcare Challenges

4. Volume of paper: up to 20 different patient registers for each facility Onerous data reporting: nurses spend 4-6 days per month aggregating data Little information flows back to the nurse: difficult to identify defaulters or high risk patients Nurse attitudes sometimes discourage clients from seeking health information Maternal & Child Healthcare Challenges For Nurses

5. Provides weekly, relevant, actionable pregnancy care voice messages in local languages 3 messages a week Tailored to stage of pregnancy and first year of child’s life Women use their own or household/compound phones Free service Provides maternal and child health information and encourages better and timely health-seeking behavior

6. Personal care during pregnancy Newborn care Recognition of danger signs Developmental milestones Nutrition and breastfeeding Malaria Immunization Postpartum family planning Diarrheal diseases Pneumonia Messages provide key MCH information for “pregnant parents” and reminders to seek timely care:

7. PROBLEM : Too much paper, too little useful information SOLUTION: Using the mobile phone for data entry and management

8. CHPS Mobile Phone System Data Entry using Structured SMS Automatic Reminders and Reports

9. Data collection & Reporting Simplified paper registers Nurses record patient data onto mForms Upload data to central database Data validation ensures high data integrity Generates monthly reports for nurses and district officials Alerts & Reminders Sends alerts and reminders to nurses and clients about patient care

10. District/RegionStatus of Implementation Kassena –Nankana West District (Upper East Region) 15 CHPS Compounds 4 Health Centers 54 Public Nurses trained 114 CHVs trained 11,274 Clients enrolled Awutu Senya District (Central Region) 17 CHPS Compounds 5 Health Centres 11 Maternity Homes and Private Clinics 127 Public Nurses trained 32 Private Nurses trained 12,509 Clients enrolled

11. District/RegionStatus of Implementation Dangbe East District (Greater Accra Region) Simplified Registers deployed: 13 CHPS 6 Health Centers 1 District Hospital 92 Public Nurses Trained in mForms: 14 CHPS 2 Health Centers South Tongu District (Volta Region) Simplified Registers deployed: 13 CHPS 5 Health Centers 1 District Hospital 1 Private Hospital 72 Public Nurses West Gomoa District (Central Region) Simplified Registers deployed: 13 CHPS 6 Health Centers 1 District Hospital 82 Nurses

12. CHPS Nurse “MOTECH has been good because it helps us with our reports. Sometimes our tallying gives us incorrect data. With the phones we know the data that we get at the end of the month is correct. We used to have to pick lots of forms in different places and take them elsewhere, now it’s much easier.” “With MOTECH we get our clients easily because we get messages listing our defaulters. Some of them also come to access services because MOTECH sends them messages telling them to come. We get people coming here telling us that MOTECH has told them to come to the facility.” CHPS Nurse “Some months ago I used to get two or three, but last month I had ten deliveries [at the facility] because the clients get the messages and they come. For postnatal they come. Even if they deliver at home they get the messages [from MOTECH] which make them come for postnatal. So I have benefited from MOTECH a lot.” Midwife MOTECH Nurse Feedback “When we see our clients for an outreach we gather them in a big group to educate them but we don’t have time to do that 1:1. Often these meetings are big and noisy so not everyone picks up what you've said. That's why MOTECH is good because it provides 1:1 information to clients along with personalized reminder messages” CHPS Nurse

13. “With MOTECH I don’t feel alone during my pregnancy, I feel that there are people that care for me and are concerned about me while I am pregnant.” “MOTECH helps a lot with preparation for birth. I felt like I had a good idea of what would happen and how to prepare practically & financially. I went to Paga Health Center & had a safe delivery.” “I liked the messages especially on the nutrition as I was able to share with my husband so he could hear it and now I am allowed to get these things such as beans, vegetables, small ground fish for the soup and sometimes meat.” Mobile Midwife: Client Feedback

14. Simplified Register Capture and store data more efficiently + Health worker focused mobile intervention information to support service delivery and continuity of care Improve work routine and time for service delivery Increase quantity and improve quality of interactions between clients and health system Phone based alerts and reminders at “critical” times to promote and encourage utilization of essential health services Improved supervision and feedback MOBILIZE SUPPLY MOBILIZE DEMAND Phone-based health education to pregnant women and new mothers to increase knowledge and awareness System effect

15. Aug 2010: Pilot in KNW District, Upper East Region Pilot in KNW District, Upper East Region Sept 2011: Replication in Awutu Senya District, Central Region March 2012: Phase II: Scale & Transition To date Full implementation in 2 districts in 2 regions – Upper East, Central Began expansion to 3 new districts in 2 new regions – Volta, Greater Accra Approximately 23,783 clients currently enrolled (2 districts) `100 facilities reporting (automated or enroute to automation) 469 nurses trained and using MOTECH

16. Integrated architecture of interoperable systems Integrated architecture of interoperable systems and infrastructures (paper, computers, internet, mobiles telephones Replicated at each administrative level: National Regional District Data Warehouse Logistics MIS Human Resource Records Medical Records Household Tracking Open LMIS iHRIS Open MRS Export e summary data Import e data DHIS2/NBIT Register pregnant women and immunization Monthly summary Reports Telephone Data from/to mobile phones Data capture from Paper reports

17. GHS HIMS Strategy Health Care Transactions and Electronic Health Records Data Warehouse and Archive Aggregated Data and Reports DHIMS (Clinical And Business Reporting) IHost (Inpatient and Outpatient Electronic Health Records) Smart phones for Service Delivery ( Public Health Electronic Health Records) Other Data Data Collection Systems (Surveys, etc) Data Warehouse For Health Care Transactions

18. GHS HIS STRATEGY Transactional Data Data Integration Data Warehousing and Reporting DHIMS2Integration Tools Clinical Information Systems Community eRegister Other Systems

19. Strong buy-in from Ghana Health Service particularly at Regional & District levels – demand to expand the platform to include other health areas. Once nurses get used to the technology they embrace it and the time it saves them for client data management Strong enthusiasm from community women – anecdotal “evidence” of healthier pregnancies, increased ANC attendance, timely immunization. National steering committee formed and chaired by Director General of GHS, similar platforms at Regional & District level actively leading the program Proposed joint initiative to scale to an entire Region, led by GHS with TA from Grameen MTN partnership: fee-based Mobile Midwife service that will cross-subsidize the free service for poor women

20. Challenges Ahead  Need for full implementation of national ehealth strategy and leadership to: ensure alignment and interoperability between MOTECH and other mhealth/ICT solutions in Ghana integration of the Nurses Application into DHIMS2 and eRegister systems  Costing/packaging MOTECH model for full integration into GHS workplans and budgets Cost of airtime remains high, need for negotiation with Telcos to bring rates down and increase network coverage Securing mobile phones in high volumes at low prices for nurses  GHS resource availability to support roll out – health sector budget already strained, Need to demonstrate the cost-efficiency of MOTECH vs. non- mhealth approaches for frontline data management/reporting and getting health information to women

21. Questions & Answers