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

Select images available for purchase in the
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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

Lessons Learned from AppLab's First Three Years in Uganda

Interesting blog post from Eric Cantor, who led Grameen Foundation’s AppLab Uganda. Nice to see that we have listened to what was learnt there, and are putting in place systems which build on that experience.

 

http://grameenfoundation.wordpress.com/2011/01/21/lessons-learned-from-applab%E2%80%99s-first-three-years-in-uganda/#more-1450

 

Creating a World Without Poverty

Lessons Learned from AppLab’s First Three Years in Uganda

By grameenfoundation

Eric Cantor has led Grameen Foundation’s AppLab efforts in Uganda for the past three years, and continues to serve as an advisor on the project.

More than three years ago, I landed in Uganda to establish Grameen Foundation’s “Application Laboratory” – a program conceived to explore the potential of mobile phones to improve the lives of the poor.  In our quest to test, develop and expand mobile services that are useful for the most often-ignored people on the planet, our team spent (and spends) extensive time talking to our users, in the places they work and live, to hear about the good and the bad of the methods we are testing to empower them.

We sit under the mango tree at the rural health clinic, hearing about how people learn to avoid and treat common and devastating diseases like malaria and HIV.  We walk the banana plantations of farmers in the West, trying to gauge how they can best control banana wilt, using locally available resources and techniques.  We observe the effects of the rapidly growing “mobile money” phenomenon – essentially digital currency delivered through a mobile phone network – and assess how it can improve the lives of villagers.  We see how people interact with the Internet and other unfamiliar services available through the few laptops and smartphones in a community.  And we listen to farming groups, led by Community Knowledge Workers (CKWs), as they plan and prepare to bulk their crops for sale to the highest-paying buyers.  As white winter washes over the US, and the rains wind down and planting season approaches in Uganda, we share some lessons learned through this work in the hopes that our growing body of work, as well as that of other practitioners in this field, will benefit.

In AppLab’s early work, we tested a number of information services, leading up to our launch, with MTN (one of the primary mobile phone services providers in east Africa) and Google, of Google SMS Tips, the product that won the award for “Best use of Mobile for Social and Economic Development” at the 2010 GSM Mobile World Congress.  It was rewarding to sit on a farm and hear how making organic pesticides using local chemicals or even waste products found on the farm helped save a farmer money, and increase her yields and incomes.

Community Knowledge Workers act as valuable local intermediaries, bridging the "last kilometer" to bring essential information to other rural farmers in Uganda. Here, a CKW uses her high-end mobile phone to check for information on banana wilt.

But what became quickly apparent was that information alone is not a complete solution.  A reference pointer or a tip about maternal health techniques may be useful to an expectant mother, but creating deep, impactful behavior change – what information-driven development initiatives seek – requires a context in which that information has a value. People certainly have a hunger for knowledge and a willingness to embrace the mobile phone to search for answers, as shown by all the questions they asked from the beginning about family planning, and HIV and other sexually transmitted infections, which affect them directly and for which few reliable, anonymous sources are available.  But we require several things to make this information actionable and impactful: specific information, a context in which to make it useful, and relevant services and resources.

We’ve also found that village-based intermediaries help increase the benefits of mobile phone-based applications.  We saw this in our Village Phone work, as well as other involvements in microfinance and social enterprises serving the poor.  CKWs are farming group leaders, nominated and elected by their peers because they meet a number of important criteria, who have been rigorously trained to harness the power of mobile technology to benefit the group.  She or he encourages, cajoles and reminds the group to farm better and organizes them to get to market, enhancing the information already being shared among the group and then funneled back to the NGOs, government agencies and buyers they interact with.  By closing the loop and covering the “last kilometer,” intermediaries like this can ensure that information is put to best use by those who can best benefit from it.  As Kentaro Toyama points out in a recent piece, “the human intent and competence ICT4D [Information and Communication Technologies for Development] aims to generate must already be in place for the technology to work.”  In the case of CKWs, the competence and intent are already in place in functioning agriculture extension programs and liquid markets. The addition of the technology through a trusted intermediary adds efficiency.  And as farmers increase yields and sell more at the market, their incomes rise.

Another thing we learned during our early work in Uganda was how carefully messages must be communicated.  With more than 800 languages spoken in Africa, and varying degrees of literacy, linguistics remains a clear challenge for mobile service practitioners.  Though we launched Google SMS Tips in Luganda, the local vernacular, it proved difficult to parse incoming queries and match keywords using the English-language logic behind the app.  Adding in one more language – let alone the remaining 45 necessary to reach all Ugandans – would have proven exponentially complex because of the overlap of words and the fact that most of those languages were not designed to be written.

That said, the challenge in communicating in a written form makes us excited about the potential for using voice-based information to deliver the message more effectively.  Few studies exist documenting the comprehension of information delivered en masse, which is understandable given that this approach is new, and that mobile provides a more scalable way to deliver information than anything that previously existed.  And even if we get users to understand the message, changing behavior based on that understanding is another step. People hear the “don’t smoke” message over and over, but they still do.  We are exploring the best ways to leverage voice-based technologies and to test comprehension and changes in behavior as the work moves forward.

The movement to realize the potential of mobile phone-based apps for the benefit of underserved markets is in its infancy, but there is an urgency to demonstrate value and share what we learn.  Grameen Foundation’s AppLab programs will continue generating insights on how best to leverage information and communication technologies to improve the lives of those who are least connected.  As we succeed or fail, we will continue to keep you posted on the journey.

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mLearning: A Platform for Educational Opportunities at the Base of the Pyramid

The GSMA Development Fund is pleased to announce the publication of its new report entitled mLearning :  A Platform for Educational Opportunities at the Base of the Pyramid.  This is an exciting area exploring how mobile devices can be used as an intervention tool to extend the reach and raise access to educational resources at the base of the pyramid. The GSMA's initial thoughts and findings have been compiled into this comprehensive report with an aim of generating the thinking that will catalyse the growth of mLearning in the future.

 

The key areas highlighted in the report are :

• The current challenges facing learning today
• The benefits and opportunities afforded to and by mLearning
• An interesting selection of case studies 
• Recommendations for Mobile Network Operators and how to get involved.

If you would like to read more about this exciting area, download your copy here

RE: Mobile money services in health care

In this two-part series, MobileActive.org explores how mobile money services can support health care in developing countries. In part one, we described the key ways in which mobile money services can be adopted by the health sector.  At the primary level of care, subscription-based mobile payment services can create two-way links between patients and health care providers, as summarized here…

http://www.mobileactive.org/mobile-money-mobile-health-use-cases

 

 

 

Live from CHIM workshop

Abigail explaining security settings in OpenMRS, then demonstrating patient search by finding CHIM's Richard Darku's record - he just registered himself using the mForms app.

Live from CHIM Workshop!

Antoinette and Freddy Amponsah of CHIM connect live to the call center through the MOTECH toll free hotline.

Live from the MoTeCH Support Center

<<DSC01454.JPG>>
Today was the first day with a fully staffed support center operating
out of their new office. Abigail and Antoinette manned our support
center in style, ready to take on any and all calls, SMS messages and
emails from all of our MoTeCH users, with gusto. They've already done a
great job over the last few weeks doing these same tasks, but now they
have a nice new, quiet home outside of the field so they can take
registration calls from Mobile Midwife registrants without a chorus of
babies at CWC outreach in the background.

Observation's from MoTeCH First CWC Outreach - July 6, 2010

The leaves of the shea nut tree at Kurugu CHPS Compound could only protect us for so long. The configuration of wooden benches, health record books, and babies fell neatly in the shade at the start of last Tuesday’s Child Welfare Clinic (CWC). But as the sun moved across the sky, families started to grow uncomfortable in the heat. Vaccinations and Vitamin A supplements were paused momentarily to move everyone back into the shade, but a few spats were inevitable as mothers differed in their recollection of who came after whom. Despite the weather, the crowds, and being several months pregnant, Community Health Officer Erica kept a cool head and managed to see all 100+ children.


Attendance at that day’s CWC was slightly higher than usual because the community got wind that MoTeCH and Mobile Midwife registrations would be taking place. However, this is a pretty typical day for the staff at a CHPS (Community Health and Planning Services) compound. Long queues of patients and few health care providers mean that each patient encounter is relatively brief and formulaic. Provision of care is centered around the big killers—polio, diphtheria, pertussis, haemophilus influenza, measles, malaria, worms, malnutrition—but with such time and staffing constraints, there is little flexibility to respond to emerging and, even worse, emergent illness. Furthermore, how do they treat the patient who isn’t at the facility to begin with?

The very first release of MoTeCH takes steps to ensure that no one falls off the map by calling patients to remind them that they are due for care. MoTeCH also identifies the patients who are past due and notifies the CHPS staff every Monday morning at 8am by text message. Previously, it would take at least a month to know that someone has defaulted. This delay can be devastating in the delicate first months of life. And once you’re done manually processing all those hand-written records to identify the at-risk individuals, there’s no time left to track them down.

MoTeCH has the potential to transform health care delivery in the UER beyond mere efficiency gains, however. Patient records are currently bound into massive ledgers: one for children, one for pregnancies, and one for sick visits. The book you are carrying that day prescribes your approach to your patient. When you are carrying your Nokia 1680 Classic with MoTeCH version 0.6.8, you are pressed to think about the patient in front of you and determine what care that individual needs. Perhaps this 4-year old is here for a weight check, but as I pick him up to put him in the weighing sling, I notice he feels warm—how long has he had that fever and cough? A pregnant woman might come in with symptoms of malaria, only for you to discover that she hasn’t had any prenatal care thus far. Having more time is great. Spending that time doing the right work is even better.

--Posted by Amanda K Johnson.  Amanda K. Johnson is a second-year MD candidate at Harvard Medical School working with MoTeCH for the summer. 

Training Nurses on MoTeCH, by Williams Kwarah

Though the use of mobile phones is permeative in my community today, its application in healthcare delivery is remote. It has never crossed my mind as to how to use a mobile phone to deliver useful health information to clients and health workers until I joined the MoTeCH team about a month ago. There, I began to appreciate the dynamism of technology, that a mobile application will not only ease the work load on the nurse but will regularly send useful and time-specific information to the pregnant woman and children. This is a wonderful innovation which will go a long way to improve the health status of rural communities. Indeed, access to health information is one major constraint that accounts for most unfortunate occurrences in healthcare delivery in rural communities. Thus, I do not only see MoTeCH as a means to unburdening the workload of the nurse and disseminating information to pregnant women and children, but an appropriate and cost-effective intervention that will promote health education in impoverished communities.

Working with Grameen Foundation is a rare opportunity that will push me into new directions whilst at the same time consolidating my vast medical experience with technology. I see it as a chance to indirectly contribute to the provision of quality healthcare services to my people.

Over the past 3 weeks, the team has been training community health officers (CHOs), midwifes and other supporting staff in the selected CHPS zones and health centres on the use of the mobile phones. These training sessions were interspersed with durbars which all fun to partake.

TRAINING

It is amazing to note that although I have not received a formal one-on-one training on the use of the MoTeCH mobile phone system, except for a couple of non-formal sessions with Maria (MoTeCH Field Officer), the system is intuitive enough for me to have been able to learn it very quickly. I have therefore participated in training the nurses in a comprehensible manner that is overwhelming. I felt honoured when I was called to take some august visitors from Monitor Group, South Africa, to see how MoTeCH was training health staff on the use of the mobile phones. I took them to Kajelo CHPS compound. There, I took the nurses through a complete training session while the visitors observed. Afterwards, the nurses were singularly interviewed. This was a great moment to interact and meet with new people and to demonstrate how MoTeCH will be working in the field. I was delighted to realize the visitors were impressed by everything; that gives me more strength to go on.

Overall, the training of community health staff has been very interesting. Most of the younger staff readily pick things quite easily, (they can use the appropriate forms when given simple and complicated scenarios), whereas the much older midwifes have various levels of difficulty. Most find it difficult to even access the MoTeCH application in the phone. Thus, for them, we have trained other supporting staff who will assist them.

Left: Williams training a midwife at Sirigu Health Centre

Notwithstanding the above challenges, we have trained virtually all the staff target to use the mobile phones on two separate sessions.

At the end of the week, we also took all mobile phones that were given to these nurses for practice back to base for configuration prior to final deployment. We also took note of the various outreach dates and venues for the various facilities to enable us plan adequately for launching and mass registration.

DURBAR

In the course of the week, we participated in a Durbar at Nayagnia to commission a CHPS compound. The event was grand with the Upper East Regional Minister, the Regional Director of Health Service, Kirsten Gagnaire (Project Manager, MoTeCH) and a host of others from Columbia University, DHMT etcetera present. The community turn-out was great! The people drummed and danced with ecstasy. Unfortunately, I did not get the opportunity to dance to the local tunes. I hope to get that some other time. I had to leave the grounds with the team just in time to have a training session at Chiana and Katiu.

Williams Kwarah is a MoTeCH Field Officer, and who very recently joined the project. He is from Navrongo.

Videos of MoTeCH Durbars

Some videos of the MoTeCH Durbars in the Upper East earlier this month have now been posted on YouTube for the enjoyment of all of those who could not attend:

http://www.youtube.com/motechghana#p/a/u/1/t87pV4fF2Jk

http://www.youtube.com/motechghana#p/a/u/0/2miVcu68HPQ

Anoinette's Journey Home to the Upper East with MoTeCH

I joined MoTeCH not long ago. I believe it was the right time though as I had the opportunity to travel with the MoTeCH team to the Upper East region to train nurses on how to use mobile phones to register patients, especially pregnant woman and children under five years; to educate people from the eleven implementation CHPS zones about MoTeCH; and to launch the MoTeCH project, which intends to enable these community members to get better access to healthcare service delivery and information to improve upon their lives.


Growing up in the Upper East region, to be precise in Navrongo, I realised access to community healthcare service delivery was a problem in the past. It has always been my dream to help improve this precarious situation or be part of a system that strives to unlock the persistent high level of poor health service delivery in our society. Thanks to Navrongo Health Research Center for improving healthcare service delivery in various communities. Ghana Health Service has also saved the situation by providing additional clinics and CHPS compounds at various communities in the district.

I have also grown to understand the needs of the people of Kassena-Nakana West district. I have realized that healthcare service delivery is a basic need for the people in the district. However, I believe that introducing MoTeCH to the district will make a great impact on the lives of the people of Kasen-Nakana West district and Upper East Region as a whole.

DURBAR
The people of Navrongo speak commonly Kasem and Nakam. They are very friendly and hospitable. I had the opportunity to interact with some communities during our durbars. I realized that organizing durbars in the communities is an effective way of communicating with the community members. During the durbars I got convinced that the messages about MoTeCH went down well with the people based on the question they asked, though there were some few issues in relation to Ghana Health services.

What interested me most in the various communities were the traditional songs, drumming and dancing; after a very long time I had the opportunity to rehearse my traditional dancing skills.

TRAINING

Training the nurses on the mobile phone was yet another aspect that exposed me to new things about the mobile phone technology that MoTeCH will be deploying. I found the training very exciting, because the nurses found it very interesting and were excited about the impact it could have on their work. Nurses were smart in understanding the operation of the phone and the various studies very quickly. We encountered poor network services which makes uploading data into MoTeCH system sometimes difficult. I think this will be a challenge for MoTeCH, though fortunately nurses can save forms on their phone to upload later when they have network. Some of the nurses raised the concerns of their facilities not having electricity or solar panels to enable them to charge the phones. Notwithstanding these few challenges, so far things are moving on well.

-- Posted by Antoinette Akanlise - MoTeCH Support Center Agent

Consumer Research/Field Data for Ghana

This site has a lot of information to inform design of applications and services for Ghana.  Thought it might be of interest to others:

http://www.audiencescapes.org/country-profiles/ghana/ghana/communication-profile-317

Maternal and Child Health News from Ghana

Upper East Region Midwife wins Midwife of the Year award from Jhpiego:
http://www.theworld.org/2010/06/11/midwife-of-the-year/


Family Planning in the Upper East:
http://www.ghananewsagency.org/s_health/r_16663/

Abigail's First Journey to the Upper East

There is always a firs time to do something and I had the opportunity to travel to the Upper East region for the first time, precisely to Navrongo. Since it was my first time to travel that far, I decided not to sleep on the way so that I can look at things on my way through out my journey. Personally for me it was a sightseeing journey. On my way to UER, just at Tamale I noticed that most people are using motor cycles and bicycles. Traffic wardens give way to these cycles to go before the cars, I found that very interesting especially the way they direct the traffic, because in Accra there is nothing like that. Also I realized that animals like sheep, goats, donkeys and cows cross the road most often.

PURPOSE FOR MY JOURNEY
Finally, I arrived in the UER (Navrongo) where our project site is and the main reason to be here is to train nurses in each of our selected CHPS zones, launch the MoTeCH project and then register patients on MoTeCH.

ORGANISING DURBARS

Due to the low level of technology and undeveloped areas in the UER, communicating information to the people effectively is through durbars. So far I have enjoyed all the durbars I attended and I have learnt new things about these people and their tradition. Some of these things are:

• At their durbar grounds the women sing to welcome us, even to the extent of bowing down to greet us. The men also drum and dance to welcome and greet us, they do this separately.
• In most of the communities I visited, they have used calabash and sheep’s skin to make a drum. The drums are played accompanied by whistles curved from wood to produce good sounds for dancing.
• They perform a “strength needed dance”, that believe me you need extra strength to this dance. Honestly, I tried to learn their dance but I didn’t get it so well because it needs so much strength.
• Talk of their environs; I call it nature at it best. A lot of baobab trees , Shea-nut trees with lots of cows, sheep, goats, pigs and donkeys grazing and some taken to the farms by the owners to carry their load to their homes. Also you find the birds also feeding on these cows, sheep etc.
• They have these fascinating names for their communities such as kayoro, Kurugu, Mirigu, nyanyai, ketui, kajelo, kananai etc.
• Languages spoken here are Kassem and Nankam and I have decided to learn the languages while am here. I have started with Kassem and here a few of the common ones spoken often.
• Good morning - Din Wor
• Good afternoon -Din wi
• Good evening -Din didan
• General greeting -din l
• Sorry -Din la
• Thank you -Akin le

TRAINING OF NURSES AND PREPARATION TOWARDS THE LAUNCH

So far, so good! The training is going down well with the nurses and they are finding it very interesting. They hope it is really going to ease the pressure and then feel good about their work. Also the people of these communities are also very welcoming and ready to join MoTeCH for this wonderful and quality health gaining project.

We are still training the nurses and preparing for the official lunch of the MoTeCH project in the first week of July. Like I said earlier on that, so far it’s been very good and we are hoping to achieve the best result out of this project.  

I am really enjoying my stay here, thanks to MoTeCH!

--Posted by Abigail Annang, MoTeCH Ghana Administrative Assistant