UN Secretary General’s Action on Women and Children’s Health Innovation Working Group – Moving From “Best Practices to Next Practices”

Scott C. Ratzan, MD, MPA

May 17, 2010

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Contents

Introduction to Women’s Health & Innovation Working Group • Countdown to 2015: The Consensus 5 Point Plan • Video: In Silence: Maternal Mortality in India • mHealth: Unleashing the Power of Innovation to Healthcare • Innovative mHealth Maternal & Infant Applications • mHealth Text4baby Application – Video: News Feature on Text4baby • Where Do We Go From Here

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( UN Secretary General Launches Global Effort on Women’s Health

“No women should die bringing life into the world. We must create a seamless continuum of care that helps improve the health of women from pregnancy through childbirth and builds the foundation for a healthy society.”

April 14, 2010

UN Secretary-General Ban Ki-moon

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Maternal and Infant Health: Key Messages

Despite significant advances over the past decades, 350,000 to 500,000 women still die in childbirth each year and some 3.6 million newborns fail to survive the first month, and an additional 5.2 million children die before the age of five – 82 percent of maternal, newborn and child deaths take place in Sub-Saharan Africa and South Asia Progress on maternal health and child health lags No Single Intervention is Sufficient Program and interventions known to work, but are underutilized and underfunded: – Comprehensive family planning – – – – – Skilled birth attendance Emergency obstetric care Antenatal and postnatal care Breastfeeding and child feeding practices Prevention and treatment of diarrhea, pneumonia and malaria Missed opportunities to get maternal, newborn and child services Progress is possible in the poorest countries

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UN Launches New Action Plan on Maternal and Child Health

“Of all the millennium goals, maternal health has advance the least and it is a key to all the rest. That is why, today we are putting women’s health front and center in the push to meet the millennium development goals.” UN Secretary-General Ban Ki-moon April 14, 2010

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Key Agenda Item

Analysis by think tank

Countdown to 2015

– General fall in maternal mortality worldwide, but progress has lagged behind in sub Saharan Africa and South East Asia where 82% of maternal newborn death occur – Considerable progress in maternal and child health in a number of low income countries “

No single intervention is sufficient.” What is needed is “a seamless continuum of care, including family planning, breast feeding, hand washing, skilled attendance at delivery and childhood immunizations.”

Dr. Flavia Bustreo Director, Partnership for Maternal, Newborn & Child Health April 14, 2010

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Progress on Millennium Development Goals 4 & 5

MDG 4 – Reduce Child Mortality MDG 5 – Improve Maternal Health 6

Countdown to 2015: The Consensus 5 Point Plan

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• Political leadership and community engagement Investing to strengthen MDGs 4 and 5 by ensuring women and children obtain the right health services. e.g., contraception, nutrition counseling • Effective health systems delivering high quality interventions along the continuum of care Currently coverage of interventions is too low, especially at time of birth • Removing barriers to access Most women and children die for lack of cost effective interventions due to healthcare disparities, e.g., poverty, gender discrimination • Skilled and motivated health workers According to the 2006 World Health Report, there are 57 critical shortage countries (doctors, nurses & midwives) • Accountability at all levels The entire healthcare system needs to remain accountable

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Skilled and Motivated Health Workers: Severe Shortages in 57 Critical Shortage Countries

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Video: In Silence: Maternal Mortality in India Nominated for a 2010 Webby Award 9

mHealth: Unleashing the Power of Innovation to Healthcare

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mHealth: Value Proposition

Saving Lives and Promoting Health Conscious Behavior Via Mobile Technology

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mHealth: Targeting Six Key Areas

Patient diagnostic and treatment support

Identifying patient symptoms correctly

Healthcare provider training & communications support

Expediting the delivery of medical treatment

Remote patient data collection

Monitoring effectiveness of treatment options

Patient education and awareness

Empowering patients to make better informed decisions

Remote patient monitoring

Increasing patient compliance with prescribed treatment

Disease and epidemic outbreak tracking

Providing decision makers with timely, location-related information

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Innovative mHealth Maternal and Infant Applications

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mHealth Applications Targeting Maternal and Child Health

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Disease Prevention

– Studies have used mobile phones for different types of disease surveillance, for example: gathering infant mortality data from 21,000 households in rural southern Tanzania.

 Shirima, K., Mukasa, O., Schellenberg, J.A., Manzi, F., John, D., Mushi, A., et al. “The use of personal digital assistants for data entry at the point of collection in a large household survey in southern Tanzania.”

Emerg. Themes Epidemiol

. 2007 Jun 1; 4:5.

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mHealth Applications Targeting Maternal and Child Health

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Chronic Disease Management

– In Norway, Gammon et al. employed mobile technology to transmit data from a diabetic child's glucometer to a parent's phone via text message. Over a study period of four months, 15 children with type 1 diabetes used the developed prototype three times per day. The investigators found that the system appealed to both parents and children with potentially fruitful approaches include integrating such systems with theory based parenting interventions that can aid in interpreting and responding to experiences of surveillance, virtual presence, and balances of power in e-mediated relationships.

 Gammon, D., Arsand, E., Walseth, O.A., Andersson, N., Jenssen, M., Taylor, T. “Parent ‐ child interaction using a mobile and wireless system for blood glucose monitoring.”

J. Med. Internet Res.

2005 Nov 21; 7(5):e57.

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mHealth Applications Targeting Maternal and Child Health

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Point of Care Health Information Tools

– A qualitative study of maternal and newborn health conducted in Dangme West, Ghana found that nurse midwives consult with their peers, supervisors, and other medical colleagues on complex cases via mobile phones. Respondents also mentioned using mobile phones to facilitate communication between patients and healthcare providers on an individual basis or en masse in communities, avoiding travel and yielding more timely and efficient health service delivery.

 Mechael, P.N. and The Dodowa mHealth Health Research Center. “MoTECH: Ethnography Report.” For The Grameen Foundation. 2009.

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mHealth Applications Targeting Maternal and Child Health

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Mobile Phones Equipping Patients with Needed Information, Innovation and Skills in Prevention and Self-Management

– An intervention called mDhil offers text messages, in 40 characters or less, with information on various health topics not commonly discussed in India, such as diabetes, H1N1, maternal health, and human reproduction, on a for ‐ profit business model. The team at mDhil is working toward one million users by the end of 2010 and hopes to hit three million by the end of 2011.

 Dolan, B. “@mHI startup boasts 150K paying mHealth users.”

Mobihealthnews,

February 3, 2010.

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mHealth Text4baby Application

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Founding Sponsor Implementation Partner

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Text4baby:A US Based mHealth Application

• • Goals – – – Demonstrate the potential of mobile health technology to address a critical national health priority, maternal and child health Demonstrate the potential of mobile health technology to reach underserved populations with critical health information Founding Sponsor Develop a base of evidence on the efficacy of mobile health interventions Implementation Partner – Catalyze new models for public-private partnerships in the area of mobile health US Based Results (First 12 weeks, through May 7 th ) –   37, 235 registered users (95% would recommend it to a friend) 67% pregnant; 33% new baby 92% English; 8% Spanish 2010

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How Text4baby Works

Outreach & promotion User registration via text/website User gives zip and due date/DOB Starter-pack of 6 key messages Free tips 3x/week Evaluation 21

Text4baby Content

Topic areas focus on topic areas critical to maternal and infant health, including:

• • • • • • • • • • Health Care Access Immunization Nutrition Prenatal Care Drugs and Alcohol Emotional Well-being Smoking Cessation Labor & Delivery Feeding Flu • • • • • • • • • Breastfeeding Mental Health Car Seat Safety Safe Sleep Oral Health Pregnancy symptoms & warnings Exercise Developmental Milestones Family Violence

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Sample Messages

Congratulations, you’re going to be a mom! Text4baby wishes you a happy & healthy pregnancy. Thanks for including us in this special time.

Back You’re not alone. If you need help, call 1-800-311-BABY (2229) for free or low-cost health care & your local WIC program.

Back A seat belt protects you & your baby. Shoulder belt goes between your breasts & lap strap goes under your belly (not on or above). Wear it every time.

Back Congratulations on your baby’s birth! Baby's 1st doctor’s visit should be 2 to 3 days after leaving the hospital. Ask your doctor when to schedule it.

Back It's normal for new moms to feel tired & overwhelmed. But if you're crying a lot or feeling anxious or hopeless, please call 800-944-4773 for help.

Back Keeping your baby’s mouth clean is important even before she has teeth! Wipe her gums each day with a wet washcloth or use a soft baby toothbrush.

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mHealth BabyCenter Application

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Tremendous Growth in mobile telephony in India Has Created Vast mHealth Opportunities

392 Subscribers in millions 34 52 90 165 261 ▪ Millions of subscribers continue to be added every month ▪ India represents the world’s largest mobile phone market ▪ Growth has not slowed and should exceed 500m subscribers by early 2010 2004 SOURCE: TRAI 05 06 07 08 2009

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BabyCenter Has Already Launched a Pilot in this Field Aimed at Pregnant and New Mothers Mobile Demo: +91 1204 078 600 The current pilot

• A mobile application covering pregnancy in English and Hindi • User interface is mixture of stage-based, pre recorded voice and daily text message reminders • Content is actionable, health and wellness information, with integrated advertising

Why this is novel

• Overcomes barriers: education/literacy, language, basic phones • Pioneers new business models for sustainability

Current status

• Consumer acceptance research has driven many product innovations • Planning to expand in 2010 with partners

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Text4baby News Feature: Southern Florida, USA

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Where Do We Go From Here

• Building greater awareness and investment by both the private and public sectors in healthcare systems delivering essential, comprehensive care to mothers and their infants • Putting a greater emphasis on addressing healthcare disparities as a global issue • Increasing emphasis on training of healthcare workers, especially in those geographic areas that show a critical shortage • Focusing on improving patient & health provider levels of health literacy • Encouraging mHealth applications to go beyond the pilot stage where there have been positive outcomes on maternal health • Addressing sustainability through innovation and public private partnerships

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Thank You

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