mHealth Field Guide for Newborn Health

CORE Group Presentation to the mHealth Working GroupKelly Keisling, CORE Group mHealth Interest Group

January 28th, 2014

CORE Group Background

• Improve and expand community-focused public health practices for underserved populations around the world• Generate collaborative action and learning with 70+ Member and

Associate organizations and partner network• Emphasis on women of reproductive age and children under five• Collaborating partner organization with the Maternal Child Health

Integrated Program (MCHIP)

CORE Group mHealth Interest Group

• Organized grants contest to support mHealth pilots for community health, in collaboration with Dimagi under NORAD IWG• Supported Learning Collaborative among mHealth grants winners• Coordinated with mHealth Working Group to co-host Deep Dive

meetings at CORE Group 2013 spring and fall annual meetings• Hosted mHealth sessions at 2013 spring and fall annual meetings

mHealth for Newborn Health

• mHealth can support integration of care across continuum of reproductive, maternal health, newborn and child health (RMNCH)• Leveraging Mobile Technologies for Maternal, Newborn & Child Health (mHealth

Alliance)• mHealth and ICT Framework for RMNCH (Labrique et al)• mHealth, eHealth, Reproductive Health (PATH)

• Early concentration of risk calls for emphasizing delivery of quality care at the time of birth and weeks after birth • Mobile Tools for Health Workers Targeting Neonatal Health in Low-Resource

Settings (Maria Freytsis of Maternity Neighborhood to mHealth Working Group Dec. 2013)

Bridge Gaps in mHealth Capacity

Awareness Knowledge

Decision-Maki

ngHQ level Field

Projects

Making mHealth Relevant to Implementation

Awareness Knowledge

Decision-Making

Practical guidance that supports decision makingRelevant to field project outcomes

Field Projects

• Primary audience: field staff Secondary: donors, ministries, HQ• How mHealth serves newborn health • Introduce and frame information resources • Frame implementation issues• Cases illustrate practical information:• Newborn health problem statement• Development process • Project management/staffing/partnerships• Costs• Results • Next steps for scale up

Cross-Regional and Cross-Organizational Perspective

• Case Studies from Various Countries• Afghanistan• India• Indonesia• Malawi

• Review Committee• Catholic Relief Services • CORE Group• PCI Global • Save the Children• World Vision

Newborn Health Interventions

High-impact, simple interventions for newborn lives in maternal child care continuum 1

Immediate focus on newborn health1. The Lancet. The Executive Summary of the Lancet Neonatal Survival Series. http://www.who.int/maternal_child_adolescent/documents/pdfs/lancet_neonatal_survival_exec_sum.pdf. Accessed Nov. 18, 2013.Nov. 2013.

mHealth for Newborn Health Interventions

Clinical Care

Outreach Services

Level of Care Ways to Strengthen Care

Family/Community

Referral and Tracking

Decision Support for CHWCHW SupervisionScheduling & Tracking Follow Up Visits

Teach & Counsel Mother and Family

Case Studies to Illustrate Use Cases

Type of mHealth Case Study

Referral and Tracking - Better Health for Afghan Mothers and Children- Reducing Maternal and Newborn Deaths- SIJARIEMAS Referral Exchange System- Chipatala cha pa Foni

Decision Support

- Better Health for Afghan Mothers and Children- Reducing Maternal and Newborn Deaths

CHW Supervision - Better Health for Afghan Mothers and Children- Reducing Maternal and Newborn Deaths

Scheduling and Tracking Follow Up Visits

- SIJARIEMAS Referral Exchange System- Reducing Maternal and Newborn Deaths

Teach and Counsel Mother and Family - Reducing Maternal and Newborn Deaths- Chipatala cha pa Foni- SIJARIEMAS Referral Exchange System

Better Health for Afghan Mothers and Children

Country: AfghanistanImplementers: World Vision and DimagimHealth Types: Referral and Tracking, Decision Support, CHW SupervisionResults: Changes in 7 health related behaviors:

- Development of birth antenatal care visit - Planning for transportation - Coordination with health facilities - Knowledge of danger signs during pregnancy -

Institutional deliveries amongst women - Early initiation of breastfeeding

Reducing Maternal and Newborn Deaths

Country: IndiaImplementers: Catholic Relief Service, Dimagi and VatsalyamHealth Types: Decision Support, Teach and Counsel Mother and

Family, CHW Supervision, Referral and TrackingScheduling and Tracking Follow Up Visits

Develop. Process: Testing with illiterate ASHA (CHW) led to development of audio and visual formats

Partnership: Technical backstopping by IT partner enabled CRS’ development of supervisor app & IT troubleshooting

Chipatala cha pa Foni

Country: MalawiImplementers: VillageReach, Concern Worldwide and partnersmHealth Type: Teach and Counsel Mother and FamilyPartnership: Collaboration with local developer of electronic

medical records prevents duplication of records Project Mgmt: Real-time monitoring reveals missed calls due to

understaffing, prompting adjusted staffing plan

Sistem Informasi Jejaring Rujukan Maternal & Neonatal Referral Exchange System

Country: Indonesia Implementers: RTI with EMAS partners (Jhpiego, Budi Kemuliaan

Hospital, Muhammadiyah, Save the Children)mHealth Types: Referral and Tracking, Teach and Counsel Mother

and Family, Scheduling/Tracking Follow Up Visits Costs: - Software development under $10,000 due to

local developers & open source software- Training, mentoring and hardware are high costs - Implementation & operating costs higher than development, but shared with stakeholders to encourage ownership.

Framing Implementation Issues and Lessons Learned

• Quality of design: Results varied for modules with more time and refinement. Sufficient time, budgeting and design methods are required.• Narrow technological approach to ICT: Testing with illiterate CHW required

redevelopment for audio/visual formats. Understand the needs of users and beneficiaries. • Changes in communication patterns: CHW may prefer calls or find SMS less

intimidating. Fit users’ communication patterns and preferences.• Changes in the power structure: Male CHW provide social permission for

female CHW to use phone publically. Gender can influence project design.• Demand: Community volunteers introduce mHealth, but lose enthusiasm.

Robust demand generation can support adoption by users and gatekeepers.

Framing Implementation Issues and Lessons Learned

• Modifications to planned implementation: Modification of complex modules takes significant time. Begin with simple features. • Project planning and management: Unrealistic time expectations resulted in design

limitations. Sufficient time, staffing and supervision are required.• Costs: Reduced costs from reused components, open source, shared equipment costs.

Costs vary but various strategies are available for reducing or sharing costs. • Organizational capacity: Projects lack sufficient capacity or staff. Trainings, guides and

technical assistance can address challenges.• Government commitment and capacity: Difficulty finding right counterpart. Align

with government goals and expectations.• Partnerships: Pilot development and national coverage involve different capacities.

Scale up can shift responsibilities to new partners.

Potential Next Steps

• Dissemination and outreach to newborn health projects• Use of guide in mHealth workshops• Adapt guide into training curriculum• Provision of newborn health use cases to developers, hackathon• Field testing of guide• Use of guide in design stage of newborn health project• Interest in potential partners

Questions, Comments, Interest in Follow Up

For further information: contact@coregroupdc.org

mHealth Field Guide for Newborn Health available: http://www.coregroup.org/storage/mHealth_Guide_for_Newborn_Health.pdf