Reaching Beyond the Grid: K4Health Malawi Demonstration Project

CORE Group Presentation by Liz McLean, MSHMay 2012

K4Health Malawi

Challenge

How can we support Community Based Distribution Agents to deliver effective FP/RH services at the community level though they are in remote locations, receive limited training and have limited access to resources available at the district and national level?

K4Health Malawi SMS Goal

Goal: Increase CHW’s access to FP/RH information through mobile telephone networking using FrontlineSMS in Salima and Nkohtakota Districts

Desired Result: Timely and accurate Family Planning and Reproductive Health services provided to men and women in hard to reach areas, reducing incidences of maternal and neonatal mortality

K4Health Malawi

Key Interventions

Formation of a national Knowledge Management Taskforce to manage and disseminate technical information on FP/RH and HIV/AIDS.

Establishment of two District Learning Centers (DLCs) at hospitals in Nkhotakota and Salima to support information flows from and to the national, district, and community levels.

Creation of an SMS-based mobile phone network to improve communication and information sharing among community health workers.

Dissemination Workshop & KM Taskforce established(December)

LDP for KM Launch (Feb)

Baseline Net Mapping (March)

Formal Capacity Building to MOH (April)

RH Toolkits published (Aug)

mHealth launch (June)

Final LDP Workshop (Dec) Some project

funding ends (June )

End Line Assessment & Net Mapping (2) (May)

mHealth Scale up (400 additional phones) (Feb)

2010 2011

LDP Coaching

2009

Needs Assessment(June-Sept)

Support to MOH sustained (July-Dec)

Mid Term Survey (Nov)

K4Health Malawi

Project Timeline and M&E Tools

Toolkit Development(April)

K4Health Malawi Design of the mHealth project

Resources: $25 mobile phones and $7 solar chargers for 663 CHWs

Partnership: Medic Mobile (FrontlineSMS); MOH; BASICS; and other SMS projects

SMS system:• SMS alert system (i.e. notification of

community vaccination dates, trainings, etc)

• Peer-to-peer SMS network (ongoing support for CHWs)

• On-demand automated FP/RH info and tips (immediate info on dosages or other

automated responses to FAQ)

K4Health Malawi

mHealth Project

In a remote area, a Community Health Worker (CHW) or client has a question.

The CHW sends a SMS to the HUB at district hospital, using a direct line or key word messaging, or to other CHWs in district.

HUB

The CHW receives an answer to their question via SMS from HUB, District Coordinator, or another CHW.

The CHW can now make a more informed decision and provide case specific guidance to clients.

SMS SystemAverage time required to contact and receive feedback from the person providing technical support:

9 minutes

Step 1: Client/CHW has a question

Step 2: CHW sends question via SMS Step 4: CHW receives

answer via SMS

Step 5: CHW takes action

District Coordinators/Supervisors receive the SMS message and respond at the HUB, from their personal phones if key word messaging was used, or another CHW responds directly.

Step 3: District responds

• Faster feedback from supervisors; with the phones the average time to receive feedback was 9 minutes as opposed to over 1 day

• Improved reporting and communication as the CHWs were able to submit reports over their phones and talk with their supervisors immediately

• Cheaper access to information as SMS only cost 11 Kwacha (MK) whereas the same information would have cost 464 MK if the CHW needed public transportation to discuss with a technical expert

• More reliable clinical information as CHWs could connect directly with technical experts at the District Hospitals

K4Health Malawi

Results

• Increased CHW self-confidence and client trust as the CHWs were able to quickly secure the technical information they needed

• Improved detection and prevention of stock-outs as the SMS allowed for constant updating

• More efficient referrals as CHWs could check to see if a service was available before referring a patient

• Widened service coverage as the CHWs were able to provide faster services, allowing them more time to reach new clients

• Prompt responses to outbreaks; the average time went from 523 minutes to 3 minutes

K4Health Malawi

Results

HIV Testing Information Family Planning Information

K4Health Malawi

June 2011 National Level Map

Satisfies both research interest and immediate project management needs

Is low-tech, low-cost, intuitive, and inter-culturally applicable

Makes implicit knowledge explicit

Is flexible for use in different contexts

By visualizing the network in which we were working, we could analyze, improve, and influence that network

K4Health Malawi

Why Net-Mapping to support our M&E?

It’s a 5 step process:

Step 1: Identify a core question: Who influences X in a certain context?

Step 2: Name stakeholders: Ask participants to identify all the stakeholders involved in their network.

Step 3: Generate the links: Ask them to draw lines to reflect the relationships they have with one another.

Step 4: Determine influence: How influential is each actor?

Step 5: Discuss and validate with participants

K4Health Malawi

What is Net-Mapping and how does it work?

K4Health Malawi

Core Question: What are the critical information flows for Malawi in improving healthcare for HIV/AIDS and Reproductive Health?

Links: - Who provides technical information on HIV testing? - Who provides technical information on family planning?

Salima District Map in 2010

K4Health Malawi

Before and After Map Comparisons at District Level

Salima District Map in 2011

K4Health Malawi

Before and After Map Comparisons at District Level

Salima 2011 mobile phone impact on communication

K4Health Malawi

Evaluation Activities: Social Network Analysis

Salima 2011 mobile phone impact on communication

‘’At first it was taking us weeks without having the supplies whenever we had stock outs, but with the coming in of this project we are able to get all the supplies that we want in time, because now it’s just a matter of sending an SMS to the supervisor.”

CBDA in Nkhotakota

K4Health Malawi

Evaluation Activities: Social Network Analysis

Questions ?