1. mHealth Reaching out to outreach health workers

2. Routine reporting Program tracking “Missed Call” SMS-reminder Low-end Smartphone Mobile literacy Mobile Apps Mobile phone Mobile web Clinical Use Public Health Treatment support Diagnostic tool Medical Sensors Voice consultation PDA

3. For routine reporting of health data from facilities/communities Robust Domesticated Not so prone to theft, preferably privately owned Long standby time on one charge (e.g. with small solar panel)charge Local service /maintenance competence Local mobile phone literacy Mobile coverage [ where there is no road, no power, no fixed line phone] Low End Mobile Phones

5. mHealth and organizational goals Improve Service Quality/Coverage or Save resources Timeliness & Data Quality Assist local decision making based on accurate data on time NB: Not all improvements have to be measurable in terms of improved health services – reduced cost burden of service provision and HMIS functions also counts

6. How can mobiles improve HMIS? Data Quality - Validation rules On the spot data capture and transfer Save time and reduce mistakes due to manual aggregation of data [overburdened health workers]  Routine data (HMIS)  Notifiable Diseases

7. Types of data Name based/program tracking (ANC, HIV, TB) or aggregate data (ISDR & routine HMIS) CHALLENGES  Security of identifiable patient data  Complexity of work routine (not easy to capture on a small screen – or any screen)  mHealth - Additional burden or Helpful tool?

8. Types of data bearers Plaintext SMS Structured SMS SIM-apps GPRS-apps (Java J2ME) Web – offline/online BUT Paper is still a viable option in many contexts

9. Empower health workers? Integrate with GIS/GPS – for disease surveillance or can be used for task force surveillance and control [Example: daily reporting Punjab] Some managers would love to have a camera- drone following their health workers 24-7!

10. Feedback What do we know about supervision? Feedback and reward from local community are significant to health worker motivation and performance Supervision feedback only when there are errors, mistakes, shortcomings Supervision is irregular and non-supportive and requires time & resources Mobiel Feedback  Progress over time  Comparisons to other organization units [vertical/horizontal]  HMIS metadata – completness, timeliness %  Push or Pull?

11. What’s in it for health workers? Save money and time spent on travel [maybe!] More time for service provision [ideally…] Closed User Group (CUG) agreement with mobile operator = free communication with colleagues Processed data Feedback Integrate with mobile payment? mBanking (MPESA) Phone Credit top-up rewards?

12. Problem of mHealth Pilots Additional burden for health workers Donor short attention span - unsustainable What works as a pilot does not necessarily scale Blindness to larger organizational and political mechanisms (health worker unions) Hard to evaluate and compare across projects

13. Partners in mHealth “Ecosystem of actors”: Ministry of Health, NGOs, researchers, Programme Donors &… Mobile Operators  Network coverage  Closed User Group Agreement  Social responsibility or New revenue streams? but mHealth Initiative may get stuck with one operator! Win-Win-Win?

14. ”This just in” TelenorTelenor going for mHealth initiatve in Norway and IndiaNorway India More than 500 projects world wide, but main challenge is scaling of initiatives.