Transcript Programme MwanaLeveraging Mobile Technology to Strengthen Health Services for Women and Children in Rural and Underserved Areas.

Programme Mwana
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Leveraging Mobile Technology to Strengthen Health
Services for Women and Children in Rural and
Underserved Areas
Mobile health technology has the power and potential to make
PMTCT more efficient and effective
The Problem
Overburdened health system and difficult to reach areas
The Innovation
Strengthen entire PMTCT system using mobile technology
How Programme Mwana improves this
Now: Decrease turnaround time for PCR test results, increase
number of results, enable real-time problem-solving
Future: Track women and children to ensure that all individuals
living with HIV are tested, enrolled in care, and treated
There are huge challenges implementing programs and tracking
progress in line with the Global Plan and MDGs
The Global Plan seeks to eliminate vertical transmission by 2015
Reduce new HIV infections among children by 90% & AIDS-related maternal deaths
by 50%
However, we have no way to accurately identify the number of
children currently infected
Using current methods, we will not know if we have reached the
MDGs until the date has passed
Current monitoring: expensive, labor intensive, retrospective, one-way information
flow
Failure to identify and enroll children living with HIV on treatment
is a critical gap in the PMTCT cascade; many of these are in remote
areas where UNICEF works
100.0
ANC
90.0
Maternal
HIV Test
80.0
70.0
Maternal
ARVs
60.0
Institutional
Delivery
50.0
Infant
ARVs
40.0
EID
Infant
HIV Test
30.0
20.0
10.0
0.0
% of women
accessing 1 ANC visit
% of pregnant
women tested for
HIV
* Median of 22 PMTCT priority countries
% of PWLWH who
received ARVs
% of Institutional
Deliveries
% of Infants born to % of infants born to
PWLWH receiving PWLWH receiving a
ARVs for PMTCT
virological test by
two months of age
Treatment
?
Source: Global HIV/AIDS Response: Epidemic update and health sector progress towards Universal
Access, 2011
Although Early Infant Diagnosis (EID) is a critical part of
elimination efforts, many think that it is an intractable problem
Challenges with EID
Other approaches have failed
•
•
•
•
•
•
Do not know true transmission
rates in countries
Lengthy transport of samples to
the central labs
Long distances that mothers have
to travel for multiple visits
Long turnaround times
Do not know whether mothers
receive results
•
•
•
•
PCR turnaround time has been the
focus, but turnaround time is not
enough
No cohort data, only cross-sectional
so hard to know longer-term results
Faster results do not necessarily mean
that infants are being treated
Lack of community interaction
Point-of-care solutions are far away
from being implemented
Mwana is the response to that is faster, cost-effective, and approaches the
problem at a systems level TODAY
Programme Mwana utilizes two main software components
• Health system focused, trained Clinic Staff
• Community focused, trained Community
Health Workers (CHWs)
All SMS are free to end users
To build the software for Programme Mwana we moved to rural
Zambia and spent six weeks co-creating it with clinic staff
Mwana increased results to mothers and decreased turnaround
time, which translates into better health outcomes
56% improvement in Turnaround Time of results
Turnaround Time to Caregiver, Pre- vs. Post-SMS System, Southern
Province, by Facility (uncensored)
Average turnaround time (days)
100
80
90
89
90
74
70
78
75
71
68
69 71
61
60
50
48
40
40
35
33
30
29
37
33
38
30
29
20
10
0
Keemba
Luyaba
Manungu
Mazabuka
Hospital
Mbaya
Musuma
Monze Urban Nakambala
Urban
Nameembo
Nega Nega
Rusangu
Facility
Pre-SMS (N=569)
Post-SMS (N=210)
Sidenberg et. all, Early infant diagnosis of HIV infection in Zambia through mobile phone texting of blood test results, Bulletin of the World Health
Organization 2012;90:348-356
Mwana increased results to mothers and decreased turnaround
time, which translates into better health outcomes
30% more results delivered using SMS
SMS vs. Hard Copy, Volume of Results Received, Luapula
Province
70
60
60
Percent
50
42
40
30
20
10
0
SMS (N=146)
Hard Copy (N=103)
Method of Result Receipt
Schaefer, Nicholson, Mugala; Monitoring and Evaluation Presentation to the Zambia Ministry of Health; 2011
A MoH Tiered Management plan allows for redundancy in
accountability
Primary Support
District
Medical Office
Secondary Support
Lab
Team
Software
Develop
ment
Team
Implementing
Partner
Health
Facility
National IT
Management
Team
Provincial
Medical
Office
Reports provide aggregated health information for the MoH
Alerts allow for real-time management of the health system
Geo-locative dashboards provide real-time information on maps
EID before Mwana was primarily an “ad hoc” system
Steps in EID Cascade
Infant born to HIV+ mother
Previous Follow-Up/Tracking System
?
Ad hoc
Clinic DBS test within 2 months
Physical paper system in clinic
but data not utilized at district or
national level
PCR lab analysis
DBS result back to clinic
?
Ad hoc
CHW finds mother
?
Ad hoc
Mother comes back to clinic
?
Ad hoc
Mother goes to ART clinic
?
Ad hoc
Mwana addresses every step of the EID cascade to ensure timely,
accurate and consistent communication and to decrease loss to
follow-up
Steps in EID Cascade
Infant born to HIV+ mother
Clinic DBS test within 2 months
Mwana Follow-Up/Tracking System
CHW registers birth and is
prompted at 6 weeks to
remind mother to go to clinic
DBS sample traced up to lab
PCR lab analysis
Result sent to all clinic staff
for retrieval
DBS result back to clinic
Clinic can initiate TRACE on
mother
CHW finds mother
CHW tells system it has
TOLD mother
Mother comes back to clinic
Mother goes to ART clinic
Potential next steps would be to add ART clinics in to Mwana –
providing a complete real-time monitoring and management tool
Steps in EID Cascade
Infant born to HIV+ mother
Clinic DBS test within 2 months
Mwana Follow-Up/Tracking System
CHW registers birth and is
prompted at 6 weeks to
remind mother to go to clinic
DBS sample traced up to lab
PCR lab analysis
Result sent to all clinic staff
for retrieval
DBS result back to clinic
Clinic can initiate TRACE on
mother
CHW finds mother
CHW tells system it has
TOLD mother
Mother comes back to clinic
Mother goes to ART clinic
?
Next steps:
FEEDBACK/VERIFY
(protocol & study design)
Mwana is scaling nationally in both countries (more sites, more
women and infants served)
Malawi
600
600
500
500
Number of EID Facilities
Number of EID Facilities
Zambia
400
300
200
100
450
400
300
250
200
100
100
0
0
2010 2011 2012 2013 2014
% National 1%
Coverage
10% 38% 60% 100%
50
0
2010 2011 2012 2013 2014
% National
Coverage
11%
22%
55% 100%
This scale up is being led by government and supported by a
wide range of partners.
Government &
UN
Implementing
Partners
Mobile
Network
Operators
Donors
Mwana is also expanding in scope across the continuum of care
Mwana as a pilot
Mwana starts scaling nationally
Mwana replicates in other countries
New modules are added
Scale across countries and continuum
Through mobile technology, Mwana has a huge potential to
positively impact health systems and reach “the last mile” more
quickly and effectively
Improves program outcomes and increases health impacts
Simplicity allows wide use and uptake in low-resource/rural settings
Real-time data enables real-time management & strengthened M&E
Builds on existing infrastructure, partnerships, and lessons learned
Engages communities in the process
Thank You
Merrick Schaefer
[email protected]
@unimps
http://github.com/rapidsms/rapidsms/