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

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

3. Global Cell Phone Usage Over 1.20.901 - 1.20.601 -.900.301 - 600Under.300 Cell Phones Per Person source: World Bank, 2011 http://data.worldbank.org/indicator/IT.CEL.SETS.P2http://data.worldbank.org/indicator/IT.CEL.SETS.P2

4. Over 1.20.901 - 1.20.601 -.900.301 - 600Under.300 87% of the global population is a mobile phone user Cell Phones Per Person source: World Bank, 2011 http://data.worldbank.org/indicator/IT.CEL.SETS.P2http://data.worldbank.org/indicator/IT.CEL.SETS.P2

5. source: CIA World Fact book 20010-11 4.5 billion users in the developing world 87% of the global population is a mobile phone user

6. 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

7. small lightweight portable connected inexpensive simple convenient intuitive accessible + opportunity

9. 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

10. countries have severe shortages of health workers 57

11. are in sub- Saharan Africa 36

12. 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 (http://www.who.int/mediacentre/events/2006/g8summit/healthworkers_large.gif)http://www.who.int/mediacentre/events/2006/g8summit/healthworkers_large.gif

13. 53% of the population of Africa owns a mobile phone source: World Bank, 2011

14. 74% of the population of Asia owns a mobile phone 53% of the population of Africa owns a mobile phone source: World Bank, 2011

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

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

17. 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

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

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

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

21. - 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. 2010 Jan;18(2):137-44. 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. 2005 Jan;:176-80. 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. 2008 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. 2009 Jan;9:51.

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

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

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

25. + 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. 2010 Jan;18(2):137-44. 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. 2005 Jan;:176-80. 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. 2008 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. 2009 Jan;9:51.

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

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

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

30. + 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

31. 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)

32. *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

33. www.instedd.org