How does MOTECH make nurses' lives that much easier?

Jessica Osborn is the Business Development Manger at MOTECH Ghana

A pregnant woman registers for the Mobile Midwife service

MOTECH Ghana is an initiative of Grameen Foundation, Ghana Health Service and Columbia University which aims to use mobile technology to improve the quality of antenatal and postnatal care for Ghanaian women and their families. MOTECH has developed an information service called Mobile Midwife which delivers time-specific voice or text messages to pregnant mothers and their partners and families both before and after birth.  We have also built a simple java-based app that enables nurses in rural Ghanaian health facilities to automate much of their record keeping and reporting, which formerly took 4-6 days per month. This nurses’ application also makes it easier for nurses to identify patients who have missed certain care.

We recently sat down with some of the nurses who use our app and here is what they told us:

A nurse describing how the app has helped with paperwork: “It’s 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.”

Our Mobile Midwife service requires pregnant parents to provide a due date and their location when they register for the service.  The service then sends messages to parents when appointments are due or overdue to remind them to visit the health clinic for check-ups.  One nurse told us, “with MOTECH we also 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.”

Another nurse really appreciated the reinforcement that Mobile Midwife messages provided for his own outreach efforts – “When we see our clients for a child welfare clinic 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 them along with personalized reminder messages.”

We really appreciate the cooperation we have received from the nurses of the Ghana Health Service in developing, testing and finally deploying MOTECH. The nurses provide critical health care services to remote communities, which is a challenging task. We’re happy to have the opportunity to make their work on behalf of Ghanaians a little easier.

 

Original post: http://www.grameenfoundation.applab.org/applab-blog/2011/03/30/how-does-motech-make-nurses%E2%80%99-lives-that-much-easier/

 

FW: USAID Lessons Learned in ICT for Distribution and Supply Chain Management in sub-Saharan African Agriculture

USAID Lessons Learned in ICT for Distribution and Supply Chain Management in sub-Saharan African Agriculture

Using ICT to manage distribution and supply chains can increase efficiency and predictability and reduce waste in value chains and have positive impacts on all market actors. ICT applications presented in this paper are divided into the following categories: 1) applications that assist in the management of supplier networks, 2) applications that facilitate traceability, and 3) applications that assist input supply companies to manage their distribution networks.

TYPES OF ICT APPLICATIONS

Management of Supplier Networks: Large buyers often use ICT applications to manage their producer supply networks. Applications address record keeping, monitoring field agent activities, procurement operations, credit and payment tasks, input distribution, measuring productivity, and forecasting.

Buyers use a range of management information systems (MIS), from basic spreadsheets to complex software used to track resources and facilitate the flow of information. Increasingly, they are using mobile phone based systems for the “channel” to reach the suppliers or their own field agents.

Traceability: Traceability refers to the recording of movements of products along the food chain from production to consumption (i.e., tracing products back to their source). For example, “relationship coffee” links coffee from its origin within a specific coffee cooperative and geographic location, increasing its retail price.

Across the globe, export standards are becoming more stringent. There is growing demand among consumers to know where their food comes from. As a result, ICT solutions that allow companies to track goods from individual farms to retail shelf are increasingly available, using, among other technologies, tracking via cell phone systems, and bar codes.

Management of Distribution Networks: Input supply companies selling seed, fertilizer, and animal feed frequently use ICT to help manage their inventory and rural distribution networks. These applications include systems that process seed orders and invoice products electronically, control inventory and costs, communicate with clients, and identify new markets. Applications vary and range from simple spreadsheets to more sophisticated tailormade applications.

LESSONS LEARNED

1. Before promoting an ICT solution, companies and development organizations must be sure of demand for the solution from existing market actors and engage those market actors in developing the solutions from the start. As noted in the prerequisites, companies must also have commercial incentives to invest in the solution. Dunavant, for example, perceived potential cost savings and efficiencies from the solutions that MTZL created and even purchased an equity stake in the ICT company once they realized how valuable the system was to them.
2. Companies should conduct an assessment of external forces and risks that could potentially affect the viability of the solution. For example, if a company’s uptake of a particular technology is premised on a strong market demand for their products, then an assessment of the market for those products should take place.
3. All users of a given technology should be given appropriate training and capacity building to avoid delays in implementation. When a new database software system is first introduced, for example, all users must be properly trained in how to effectively enter data, track production, and run reports.
4. An ICT solution has costs for operations, maintenance, and occasional upgrades. All costs need to be considered up front when gauging how much the system is worth to those benefiting—and how much they will pay for it. All too often such solutions begin during a donor project only to end at project close because no one anticipated how these operating expenses would be paid. Companies and development organizations also need to be aware of the enabling environment for certain technologies. For example, government regulation of RFID technology may limit its use.
5. Using such systems in developing countries may require adaptations due to the cost or lack of availability of telecommunications services. For example, pineapple growers in Ghana can comply with traceability requirements by recording pineapples from origin to pallets in a packing shed in the field and simply transport that information to the port via a ‘data stick’ carried by the truck driver rather than transmitting it electronically. At the port, the data can easily be transferred into the international traceability system for the pineapples, tracking them onward from the port to their destinations in Europe.
6. This set of applications are often financed and operated by large buyers, processors or exporters given how valuable they can be for them. USAID projects need to be especially cautious if heavy subsidies are requested by such large companies—it is likely to be a sign that the system has been designed in a way to outweigh its core value to these large companies

ICT Applications for Distribution and Supply Chain Management in sub-Saharan African Agriculture is one of a series of briefing papers produced by the FACET project to help USAID missions and their implementing partners in subSaharan Africa use information and communications technology (ICT) more successfully — via sustainable and scalable approaches — to improve the impact of their agriculture related development projects including Feed the Future projects.

http://feedproxy.google.com/~r/Ictworks/~3/BeNVlHtUA10/usaid-lessons-learned-ict-distribution-and-supply-chain-management-sub-saharan-afric

 

Health care by phone? There's an app for that

http://www.pressherald.com/news/health-care-by-phone_-theres-an-app-for-that_2011-03-13.html

 

March 13

Health care by phone? There's an app for that

Using mobile technology, a USM team helps bring medical care to the rural poor of Ghana.

By John Richardson jrichardson@mainetoday.com
Staff Writer

PORTLAND - Bruce MacLeod has seen how digital technology can improve medical care in developing countries since he helped introduce computers and floppy disks to Sudanese health centers 30 years ago.

click image to enlarge

Bruce MacLeod, a computer science professor at USM, works with students on mobile phone health care for the poor of Ghana and Nigeria. From left are MacLeod, Brent Atkinson of Hollis, Matt Blanchette of Scarborough, Brian Hartsock of Oakland and Dave Roberge of Auburn.

Courtesy University of Southern Maine

click image to enlarge

Brent Atkinson of Hollis was part of the University of Southern Maine team that helped create the Mobile Midwife program for nurses and pregnant women in Ghana. He is shown deploying the system last fall in Navrongo, Ghana.

Courtesy Professor Bruce MacLeod

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But mobile technology -- the ordinary cell phone -- is a powerful new tool, according to the University of Southern Maine computer science professor.

MacLeod and two of his graduate students helped create a system that uses cell phones to improve the delivery of health care to pregnant women and newborns in a poor agricultural region of Ghana. The system -- known as Mobile Midwife -- has been operating since last fall, and parts of it may soon be replicated in India and other poor areas of the world.

Nurses in northeast Ghana can now keep electronic medical records, filling out forms and retrieving patient information using cell phones. And pregnant women and new mothers are getting regular cell phone messages telling them about the importance of good nutrition or reminding them when they are due to get a pre-natal exam or have their child immunized.

"In the last five years, it's been more about mobile technology, which represents an incredible revolution in the way information is handled," MacLeod said.

While land-line telephones, laptop computers and the World Wide Web are often not available to the poor, inexpensive cell phones -- and the towers to serve them -- have become common in remote, rural regions such as northeast Ghana.

"That's their primary communication," said Matt Blanchette of Scarborough, who worked full time on the project before and after receiving his master's degree from USM last year. "Where we have things like Internet connections and Wi-Fi, they really have the cell phone network."

In northeast Ghana, where families live in rustic compounds, about 60 percent of households now have access to a cell phone, MacLeod said. Some households share, he said, although "everyone wants to own a cell phone."

In fact, Ghanaians are much more sophisticated with their phones than Americans, he said. They use them to do electronic banking and to check prices at the market, for example.

The Bill and Melinda Gates Foundation saw the potential for improving health with the phones more than two years ago, when it financed a project called Mobile Technology for Community Health. MacLeod and his students were brought into the project by Columbia University to create the applications, or programs. Other partners included the Grameen Foundation, an anti-poverty organization, and the Ghana Health Service.

The Gates Foundation had a simple challenge, MacLeod said: "Can you use mobile phones to save lives?"

It took about two years to create and launch the system. Most of the programming work took place on the USM campus in Portland. MacLeod and Brent Atkinson of Hollis, one of his students, traveled to Ghana to work with nurses and develop and trouble-shoot the system.

Nurses in district health centers now use their phones to fill out electronic forms, such as when a child is born or is immunized. They can easily keep track of exam schedules and look up whether a young mother has had a tetanus shot, or if a family has mosquito netting to prevent malaria.

Before, all record-keeping was on paper, and it took much longer to fill out and retrieve medical information. Saving time is important to the nurses, who serve as the only health care providers in rural areas.

Women in the region are asked to sign up for the message service, and it has become a popular phone app.

The women get periodic calls with recorded health messages. Texting didn't work because there is no written equivalent for the local language, MacLeod said.

One weekly message might remind pregnant women that mangos are a good source of vitamin A. Another might say that, despite cultural traditions, there is nothing shameful about going to a health center.

Other messages are specific, such as automated reminders when a woman is due for an exam or a child is due for immunization.

It took two years and millions of dollars to create the system from scratch, MacLeod said. USM's piece of the project cost about $300,000, he said.

But it operates with technology that's readily available in Ghana.

"One of the things that has everybody's attention is that we did it with a $40 phone," MacLeod said. The $40 phones are the ones that nurses use to keep records. Patients can use their standard phones, which typically are sold for $5 or less, he said.

While USM is wrapping up its piece of the project, others will monitor the communities to see whether the technology actually does save lives, such as by reducing infant mortality rates.

"I think it can in the long term," Blanchette said.

The Gates Foundation and other organizations hope to replicate the system in other parts of Ghana, as well as a region of India that has much higher mortality rates, MacLeod said.

Blanchette said he plans to work on those efforts. Atkinson, the former grad student from Hollis, is now in Kenya working on a similar project.

MacLeod, meanwhile, is leading a new team of graduate students -- Brian Hartsock of Oakland and Dave Roberge of Auburn -- working to bring digital technology to health centers in Nigeria so they can keep track of health data and trends.

"In a sense, the health system is running blind," MacLeod said. "We're going to use the same tricks as in Ghana."

Staff Writer John Richardson can be contacted at 791-6324 or at:

jrichardson@pressherald.com

 

Text Messages Can Help Improve Adherence to ART

Text Messages Can Help Improve Adherence to ART
Sending your patients short text reminders every week may help improve their adherence to antiretroviral therapy.
Mobile phones are already being used to deliver novel health interventions, but few data are available on their use for this purpose in resource-constrained settings, where cell phones are now ubiquitous. In this prospective randomized trial in Kenya, researchers provided 428 HIV-infected patients with mobile phones and then evaluated whether reminder text messages would improve their adherence to antiretroviral therapy (ART).

All the patients had initiated ART in the 3 months prior to study enrollment (mostly with AZT/3TC + nevirapine), and 97% resided within cell phone network range. One third of the patients served as a control group, while the others received either short or long text messages, delivered either daily or weekly. The short messages were simply reminders, whereas the long messages also included words of encouragement. Adherence was monitored using MEMS (Medication Event Monitoring System) bottle caps.

At 48 weeks, 16% of all study participants were lost to follow up; the proportion did not differ significantly among groups. In the control group, adherence was 76% overall and declined during follow-up, with only 46% of patients achieving high adherence levels (>90%) in weeks 37 through 48.

In a 48-week intent-to-treat analysis, weekly reminders had a positive effect on adherence, but daily reminders did not. Whether the messages were long or short did not seem to matter. The proportion of patients who achieved high adherence levels was 53% in the weekly-reminder groups, versus 41% in the daily-reminder groups and 40% in the control group. Similarly, the proportion of patients who interrupted treatment for at least 48 hours was 81%, 86%, and 90%, respectively.

Comment: This study demonstrates how much we still need to do to improve adherence to ART in developing countries. Only about 45% of patients in this study had high adherence levels, and although viral-load data were not presented, we can predict that rates of virologic suppression were not optimal. Reminder text messages may be an effective means of improving adherence to ART among patients in resource-limited settings who have cell phones, as long as the messages are kept short and sent only weekly.

— Carlos del Rio, MD <http://aids-clinical-care.jwatch.org/misc/board_about.dtl>
Published in Journal Watch HIV/AIDS Clinical Care <http://aids-clinical-care.jwatch.org> February 18, 2011
Citation(s):

Pop-Eleches C et al. Mobile phone technologies improve adherence to antiretroviral treatment in a resource-limited setting: A randomized controlled trial of text message reminders. AIDS 2011 Feb 10; [e-pub ahead of print]. (http://dx.doi.org/10.1097/QAD.0b013e32834380c1 <http://dx.doi.org/10.1097/QAD.0b013e32834380c1> )

Links Between mHealth and Mobile Money

http://www.pbs.org/newshour/updates/health/jan-june11/mhealth_02-24.html

 

I Left My Heart in Navrongo: Visiting the MOTECH Project in Ghana

Ellen Yiadom is Grameen Foundation’s Africa Legal Fellow. She graduated from the University of Virginia School of Law in May 2010 and is a recipient of Dewey & LeBoeuf’s Community Service Fellowship.

Last November, I visited Grameen Foundation’s Mobile Technology for Community Health project (MOTECH) in Ghana. The project covers 15 health facilities in Kassena-Nankana, a district in the Upper East Region that is only a few miles from Ghana’s northern border with Burkina Faso. I was there to observe the operations of the project and help the field staff update patient care information.

We flew into Tamale, the capital of the Northern Region of Ghana, and drove two hours to Navrongo, which became my base for this trip. As we drove from Tamale to Navrongo, I was impressed by the lushness and serenity of the natural landscape, which was a contrast to the bustle of Accra, Ghana’s capital, where I was born.

Although there was very little human activity along the road, small towns would spring up along the way and the road would quickly become populated with people on bicycles, motorbikes and even an occasional donkey. These small vehicles often included several passengers. I even saw very small children riding behind or in front of their parents seemingly without fear.

Upon arriving in Navrongo, I visited a health facility in Kurugu, a sub-district in Kassena-Nankana, to help update patient care information in the MOTECH system that provides customized health information to pregnant women through mobile phones.

One key service is Mobile Midwife, which provides weekly phone calls and text messages to women about prenatal and postnatal care.  After registering for the service, pregnant women receive information tailored to their stage of pregnancy, while women with newborns receive vital information during the baby’s first year of life. For example, if a woman is six weeks pregnant, she would receive information about what to expect during her first trimester.  Additionally, the messages encourage the women to visit the nearest health facility throughout their pregnancy and give them tips on staying healthy during their pregnancy. Because Mobile Midwife is run through an Interactive Voice Response Server, women can call in to listen to any messages they may have missed. There’s also a call center where women can ask questions about technical issues such as the alerts and messages they are receiving; staff in the field also go out to meet with women who are more comfortable speaking in person than over the phone.

As the women come in for their health check-ups and their immunizations, the nurses keep records of this information by entering it into the mobile phones they received as part of the MOTECH project. This enables women who are registered with MOTECH to receive automatic notifications about any immunizations they need. The nurses can also enter information about upcoming appointments and the server will send automatic reminders to pregnant and new mothers. Of course, if the patient care information is not entered, or entered incorrectly, then the women will receive inaccurate alerts and reminders, so it’s very important for the nurses to update in a timely, accurate way.

During my time in Navrongo I visited other health facilities and was able to meet some of the participants in Mobile Midwife. One of them was Cecelia Ayebe, who had given birth the week before we arrived. She showed us her beautiful baby girl, who looked quite big and healthy for a one-week-old. When asked about the main difference between this pregnancy (her second) and her first, she explained that she became more informed and proactive about her care after listening to the Mobile Midwife messages. For example, she learned that she had to visit the nearest health facility when she experienced certain pains. Consequently after experiencing pains in her womb she visited the nearest health facility and learned that her baby was not positioned well. In her local culture, women are often discouraged from visiting a health facility when they are experiencing pain during their pregnancy. Without the information from Mobile Midwife, she might have ignored the pain, and possibly hurt her baby.

Despite having almost no formal education, the other women I met during my time in Navrongo were dedicated to improving the health of their families – just like Cecilia. MOTECH offers them the information they need to have a healthy pregnancy and baby.

 

Original post at: http://grameenfoundation.wordpress.com/2011/02/11/i-left-my-heart-in-navrongo-visiting-the-motech-project-in-ghana/#more-1477

 

 

FW: ODK Clinic

Aliya recently ran across ODK clinic, which allows a mobile interface
for OpenMRS on
android phones. This is the type of functionality we have discussed for
MoTeCH if Ghana Health Service (or other implementations) want to move
to a truly paper-less system for nurses. Might be worth looking into
this more deeply as a starting place when we're ready to investigate
this type of functionality more deeply.

http://code.google.com/p/opendatakit/wiki/ODKClinic