Mobile Literacy for HealthEnhancing Communication, Mobile Literacy, and Monitoring Applications to Improve Health Service Delivery in Uganda

2012–2014

C A S E S T U D Y

F A C T S A T A G L A N C E

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Mobile Literacy for Health Enhancing Communication, Mobile Literacy, and Monitoring Applications to Improve Health Service Delivery in Uganda

SUMMARYFrom 2012 until 2014, the Kellogg Institute for International Studies’ Ford Family Program in Human Development and Solidarity integrated information and communications technology into Nnindye’s village health activities. The project improved the local hardware required to support this increased capacity through an $85,000 grant from the Verizon Foundation. Technical staff from the Notre Dame Initiative for Global Development (NDIGD) and the Office of Information Technologies (OIT) worked with faculty and a student at the Eck Institute for Global Health to carry out training activities and data collection. This collaboration led to improved health outcomes for local residents by improving access to information and treatment, increasing the monitoring and reporting capacity of the local village health team and center, and strengthening the ability of the local village health team to effectively interact with the community members to improve health-seeking behavior. Similarly, through improving mobile phone literacy for the broader community, communication between the residents and their local health staff was expected to improve.

BACKGROUNDThrough the Ford Program, the Kellogg Institute seeks to advance the study and practice of human development by engaging with communities facing a variety of complex challenges.

The Ford Program promotes a holistic model for human development, partnering with local institutions and local residents to better understand the complex and interrelated issues affecting the development process—and together turn that knowledge into action.

With the recognition that local leadership must drive project planning and implementation, and community ownership is the cornerstone of sustainability, the project engaged local partners in Uganda and Kenya.

Given the challenges rural communities face in accessing quality healthcare, a new model of service delivery is required to bridge the gap from existing monitoring protocols to traditional health-seeking behavior and the local human resources available for treatment. Because Nnindye’s residents have already highlighted the importance of improving their local healthcare, this project addressed that issue. NDIGD, OIT, and the Eck Institute for Global Health participated in these efforts by working together on applications of mobile technology, training of village health workers, and improving the mobile literacy of the community residents. As a result, Nnindye has gained wider access to higher quality care than had been previously possible. At the same time, implementation allowed

F A C T S A T A G L A N C E

PROJECT NAMEMobile Literacy for Health

CITY / COUNTRY Nnindye Parish, Uganda

REGION Sub-Saharan Africa

IN-COUNTRY COMMUNITIES Uganda Martyrs University

PROJECT DURATION 2012–2014

SPONSOR Verizon Foundation

NOTRE DAME PRIMARY The Kellogg Institute’s Ford Family

Program in Human Development Studies and Solidarity

NOTRE DAME PARTNERS Eck Institute for Global HealthNotre Dame Initiative

for Global DevelopmentOffice of Information Technologies

TOTAL PROJECT COST $107,593

TOPICAL AREAS Global HealthHuman Development

C A S E S T U D Y

Notre Dame Initiative for Global Development 3

Notre Dame student working with a member of the community

C A S E S T U D Y

the University of Notre Dame to engage with faculty and students at Uganda Martyrs University (UMU) to contribute to the rollout of mobile and computing technology to the village health team, health center, and community center. Notre Dame and UMU were also able to investigate the success of the initiative and add to research regarding the most effective approaches in using technology to improve health outcomes.

OBJECTIVES The objectives identified for this project were as follows:

• Improve performance on basic mobile platforms

• Improve the understanding of activities at the health clinic

• Improve health seeking behavior

IMPACT OUTCOMESOverall, the project improved clinic operations, an outcome not indicated or expected in the initial design. Perhaps the observation protocol established to record activities at the clinic level, combined with the accountability inherent in sending text messages to the community to inform of clinic activities, encouraged clinic staff to operate more effectively. This unexpected outcome was one of the most pleasing results of the project. Similarly, attendance at the clinic of working adults and the elderly increased.

In addition to improving wait times, some residents did report lower incidences of sickness. However, this effect was not as large as envisioned. Analysis seems to show that the text messages were actually very effective at reaching individuals without phones—that is, given the close-knit relationships within the community, even individuals who did not receive text messages learned of the message content through family members, friends,

A mother with her child after vaccination at the clinic

The clinic in Nnindye

Getting information about village clinic health services is indispensable for child vaccinations

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and neighbors.

Given the low knowledge base regarding mobile phone usage, especially beyond receiving phone calls, the mobile literacy portion of the project greatly improved capacity of training program participants. Around half of the adults in the community received this training on basic mobile functions, including initiating phone calls, receiving text messages, and composing text messages. Surprisingly, prior to the training, 35% of participants could not identify when they had received a text message.

The key findings can be summarized as follows:

• Community members reported that the text messages helped improve their knowledge of clinic operations, and improved their overall satisfaction with the services provided.

• Children of mothers who received text messages regarding clinic services exhibited an 11% decline in illness. Interestingly, considering all other factors to be equal, the economists attribute this difference to the text messages themselves.

• Attendance increased at the clinic, particularly among working adults and the elderly. For both of these population groups, visiting the clinic demonstrates a costly investment, either in time lost, effort taken, or wages foregone. Effectively reaching this population and driving their increased attendance at the clinic should be seen as a key result of the program’s efforts.

• Observations at the clinic from before and after the intervention began revealed that wait times for community members seeking care declined from two or more hours to as little as 15-30 minutes. In addition, the attendance of clinical officers improved.

The project facilitated the connection of the clinic’s computer to the internet via a wifi bridge to the Uganda Martyrs University Campus. This ensures that the clinic maintains the capacity to send text messages directly to community members through the Frontline SMS platform.

Additional benefits were found as a result of the text messages. Such benefits include:

• The clinic is able to readily access online tools to improve their monitoring and evaluation of community health for Nnindye’s residents.

• With the ability to more easily exchange information with district and ministry health officials, the clinic is able to ensure that all parties are up to date on disease indices and the overall community health status.

• The clinic is able to serve as an information resource, especially when the presiding physician is not available and the cases are being managed by fewer well-trained clinic staff.

All of these results have improved the delivery of services at the clinic level, and on a limited basis, have improved the health status of the community members, who are now reporting to the clinic in greater numbers. Some of the credit for this increase is certainly due to the activities of the project. Hopefully the continued use of the messaging platform will continue to drive up attendance and drive down wait times.

Children gathering water at a local well

Children at the clinic

Data collection training