1. Using Information for Project Design: mHealth in Mozambique Research for Improving Program Performance Alfonso Rosales, MD, MPH-TM Technical Specialist, Maternal and Child Health World Vision US

2. Project Background Location: Two administrative posts in Nicoadala District, Zambezia Province, Mozambique Maternal Mortality Rate: 490/100,000 (19 th ) Infant Mortality Rate: 72/1,000 (11 th ) Health Infrastructure: 1 provincial hospital, 5 rural hospitals 179 health centers, 153 vaccination posts Purpose: To determine if mobile phones could improve the quality of services delivered by Community Health Volunteers (CHVs) Funding: Grand Challenges Explorations Grant / Gates Foundation Discovery Program $100,000 over 2 years

3. mHealth Theory of Change Natl & Intl Goals to which project contributes Improved prevention and treatment of disease Develop Operating Plan Refine business needs & requirements Increased adherence to treatment protocols Improved efficiency and effectiveness of community case management Foundational activities Intermediate Outcomes Long-Term Outcomes to which project primarily contribute Finalise M&E plan and conduct baseline Consolidate sustainability plan and partner relationships Establish programme management Training, curriculum and partner development Improved health & well- being of children Improved access to health information, guidance and social services Build and sustain user capacity & ownership Communicate project- roadmap, benefits, project management Improved maternal care and emergency response Lower infectious disease rates Deployment activities Develop solution based on user needs Activity tracking, monitoring & evaluation On-time and improved quality of monitoring and reporting Design budget & sustainable financial model Undertake user acceptance testing Train users on all aspects of solution Lower child mortality rates Improved maternal health Millenium Development Goals mHealth Theory of Change

4. Project Background Hypothesis: mobile phone technology can improve quality of services provided by community health workers Variables: -Identification of pregnancy complications -Timely referral rates -ANC rates -Institutional delivery -Postpartum and newborn care rate Method: register review

6. Information Collected Quantitative How: A pregnancy and postpartum module installed on the mobile phones guided CHVs through an algorithm of danger signs, non-urgent questions, reminders, and advice to facilitate a safe pregnancy. Data was stored in the phone and transmitted to the project’s database. Period of data collection: June 2011-October 2012 Qualitative How: two focus group discussions with CHVs participants

7. Information Collected What: Quantitative Data: 750 pregnant women and 393 postpartum period Overall complication rate of 20% (prenatal 6%, postnatal 14%) Birth preparedness: 64% (women with complication) Referral completion: 91% (94% prenatal, 47% postpartum) Technical support when danger sign cited : 95% Qualitative Data: Focus Group Discussions Confidence in mobile device use Algorithm supported decision-making process Improved communication with health facility Increased credibility

8. Using the Information Who: Stakeholders National Level Partners: Mozambique Ministry Of Health Humanitarian Partners: USAID, SCIP, Technological Partners: Commcare, Dimagi What: use of mobile technology by CHVs associated to high recognition of danger signs (prenatal/postpartum) high prevalence of birth preparedness Increased technical support from HF with complicated cases How: Improved program design Supervision approach Scale-up, other applications: newborn module

9. Using the Information Challenges: Phones Local access to appropriate technology Difficulties in accessing data Registration of SIM cards (local) Mobile phone charging Participants: Limited literacy skills Poor eyesight Misuse of mobile technology Project design Utilization and access Knowledge

10. Using information: solutions Technology: Solar charges Adequate airtime allowance Development of version II Personnel: Training Challenges: Reading glasses and audio prompts Refresher training Implementation Challenges: Supervision at local level Program Design Strengthening communication Newborn module

11. Moving Forward Scale-Up: Increase coverage area Two-way referral system Newborn module Technical Supervisor Barrier Analysis: Social and Structural Research: Experimental Design: Intervention and Comparison Groups