1. emHELP and supporting EGPAF Tanzania mHealth Working Group meeting, 15 August 2013 Peter Benjamin mHealth Alliance

2. Mhealth Alliance | 2 Outline emHELP – capacity building arm of mHealth Alliance Technical Assistance with EGPAF Tanzania Lessons learnt & next steps

3. Mhealth Alliance | 3 Needs for building capacity in mHealth Great and increasing interest in mHealth Lack of proven models of what works Great potential Also considerable scepticism Good experience in the many organisations But difficult to access expertise

4. Mhealth Alliance | 4 QuestionsBody of knowledgeIssues 1. FUNCTIONING Does the system function properly? Technical design, Systems analysis. Software, hardware, network Need to understand the medical problem being addressed. Levels of Evidence for scale in health system

5. Mhealth Alliance | 5 Technical design, Systems analysis. Software, hardware, network 2. USABILITY Will people use it? QuestionsBody of knowledgeIssues 1. FUNCTIONING Does the system function properly? Technical design, Systems analysis. Software, hardware, network Need to understand the medical problem being addressed. 2. USABILITY Will people use it? Will people keep using after 6 months? User-centred design, Soft systems design, marketing, training, workflow. Human-computer interface. Usability, literacy, language Usability by end users (e.g. public, patients, health workers), people who use the data (e.g. health managers) - very relevant within the health system (failure in electronic system in police). For public-facing services, issues of advertising, marketing, retention. Levels of Evidence for scale in health system

6. Mhealth Alliance | 6 Technical design, Systems analysis. Software, hardware, network 2. USABILITY Will people use it? Will people keep using after 6 months? User-centred design, Soft systems design, marketing, training, workflow. Human-computer interface. QuestionsBody of knowledgeIssues 1. FUNCTIONING Does the system function properly? Technical design, Systems analysis. Software, hardware, network Need to understand the medical problem being addressed. 2. USABILITY Will people use it? Will people keep using after 6 months? User-centred design, Soft systems design, marketing, training, workflow. Human-computer interface. Usability, literacy, language Usability by end users (e.g. public, patients, health workers), people who use the data (e.g. health managers) - very relevant within the health system (failure in electronic system in police). For public-facing services, issues of advertising, marketing, retention. 3. IMPACT Does it have any impact? Measures of health systems efficiency or health impact. Epidemiology. Intervention studies Studies to develop the evidence base, with ethical approval as required. Need for formal methods, beyond internal project monitoring. Levels of Evidence for scale in health system

7. Mhealth Alliance | 7 QuestionsBody of knowledgeIssues 4. SCALE Will it work at large scale? Health systems at scale. Systems implementation science. Change management. Training /capacity building /support Integration with wider health systems (DHIS etc). Quality control. For health systems, threshold of scale around 1,000 facilities or health workers; for public- facing mHealth 100,000 active users. By these measures, only scaled mHealth in SA are BabyInfo on MXit (750,000), Praekelt’s Young Africa Live (1.6 million); and Cell-Life’s Clinical Data Collection (984 facilities). Several others plan for scale in coming year. Levels of Evidence for scale in health system

8. Mhealth Alliance | 8 QuestionsBody of knowledgeIssues 4. SCALE Will it work at large scale? Health systems at scale. Systems implementation science. Change management. Training /capacity building /support Integration with wider health systems (DHIS etc). Quality control. For health systems, threshold of scale around 1,000 facilities or health workers; for public- facing mHealth 100,000 active users. By these measures, only scaled mHealth in SA are BabyInfo on MXit (750,000), Praekelt’s Young Africa Live (1.6 million); and Cell-Life’s Clinical Data Collection (984 facilities). Several others plan for scale in coming year. 5. ECONOMIC Is it cost-effective? Health economics. Measures of QALY (or equivalent). Business model. Value chain analysis. Issues of ongoing sustainability (capacity, organisational, financial). Clarity on who the ultimate payer is, and how all parts of value- chain benefit. Levels of Evidence for scale in health system

9. Mhealth Alliance | 9 emHELP eHealth & mHealth Expert Learning Network The capacity building arm of mHealth Alliance Network of advisers & consultants on mHealth (topic areas & in-country) Question answering (free) “How To” guides for main issues Technical Assistance & consulting University certified training National engagements (currently) -Tanzania with EGPAF - South Africa policy

10. Obstacles to implementing mHealth from partner discussions BASIC RESOURCES: Funding Short-term funding / sustainability issues Difficulty scaling pilots GOOD HUMAN RESOURCES: Lack of competent workers with mH experience Training & Capacity building AWARENESS: Awareness of doctors in using mHealth Education of Govt and health organizations of mHealth Public awareness & education about mHealth INFRASTRUCTURE: Reliability of cellular networks Recharging in rural areas Cost of devices / SMS / mobile internet bandwidth COLLABORATION: Cooperation and local networks supporting mHealth

11. Basic fact-finding Establish groundwork for Needs Assessment mHealth Recommendations Exploratory Mission Determine feasibility Determine strategic value Prioritize recommendations Determine TA skills and SoW Collect baseline data Identify workflows, Info, flows and processes Obtain MoHSW. buy- in Prelim.. basic capacity- building Needs Assessment Strengthen organizational mHealth capacity Operationalize prioritized recommendations Finalize Needs Assessment Tool Develop M&E framework to measure impact Technical Support Consultancy 1) Increased mHealth capacity of EGPAF 2) Increased program impact 3) Prototype for builidng org. mHealth capacity 1) Increased mHealth capacity of EGPAF 2) Increased program impact 3) Prototype for builidng org. mHealth capacity Build the capacity of EGPAF Tanzania to strategize, implement, monitor and manage mHealth integration into EMTCT programs Identify the needs & skills required to fill the needs Understand the mHealth ecosystem & stakeholders Understand the capacities Identify the skills needed to build capacity Targeted TA to build organizational capacity to integrate mHealth to improve program impact Goal: Objectives:

12. Review documents Exploratory Mission Report EGPAF Tanzania Progress Report Tanzania mHealth Public-Private Partnership Report -Finalize TA Action Plan -Identify Baseline Data Indicators and M&E Plan Develop Methodology Identify and Adapt Assessment Tool(s) and Questionnaires Conduct Needs Assessment -Prepare Needs Assessment Report and Technical Support SoW; -Revise Adaptable Tool -Recommendations

14. provide decision-support for health workers to provide appropriate quality care in all patient encounters will allow health workers at the health facilities to enter data on patients and health encounters, to retrieve individual patient record information and appropriate reports on patients for management of care (including contacting patients who are lost to follow-up) send clinical care SMSs to the female patients to encourage attendance at the facility

15. EGPAF: “Owner of the project”, All implementation logistics mHealth Alliance: Technical Assistance, needs assessment, building capacity of EGPAF, M&E D-tree International: Technical implementer Electronic protocols, data collection, backend University Computer Centre: Health systems links

16. Mhealth Alliance | 16 Current status & next steps MOU & SOW late drafts, signing in August Develop and test electronic protocols & data collection in September Meetings with MoHSW & partners in September Implement from October in 10 sites Nzega (Option B+) M&E and track for 1 year

17. Mhealth Alliance | 17 Lessons Learnt Importance of strong partnerships Build on existing tools – many moving parts, try to simplify & take small steps Need Ministry involvement from the start Need to learn at each stage to continuously improve – quality control & feedback

18. Thank You! Dr Peter Benjamin mHealth Alliance eHealth & mHealth Expert Learning Program (emHELP) pbenjamin@mhealthalliance.org +27 82 829 3353 Skype: peterbenjamin “These tools don’t get socially interesting until they are technologically boring” Clay Shirky, 2011