Using Information for Project Design:

mHealth in Mozambique

Research for Improving Program Performance

Alfonso Rosales, MD, MPH-TM

Technical Specialist, Maternal and Child HealthWorld Vision US

Project Background

Location: Two administrative posts in Nicoadala District, Zambezia Province, MozambiqueMaternal Mortality Rate: 490/100,000 (19th) Infant Mortality Rate: 72/1,000 (11th)Health Infrastructure:

1 provincial hospital, 5 rural hospitals179 health centers, 153 vaccination posts

Purpose: To determine if mobile phones could improve the quality of services delivered by Community Health Volunteers (CHVs)

Funding: Grand Challenges Explorations Grant / Gates Foundation Discovery Program

$100,000 over 2 years

mHealth Theory of ChangeNatl & Intl Goals to which project contributes

Improved prevention and treatment of disease

Improved prevention and treatment of disease

Develop Operating

Plan

Develop Operating

Plan

Refine business needs

& requirements

Refine business needs

& requirements

Increased adherence to treatment protocolsIncreased adherence

to treatment protocols

Improved efficiency and effectiveness of community

case management

Improved efficiency and effectiveness of community

case management

Foundational activities

Intermediate Outcomes

Long-Term Outcomes to which project primarily contribute

Finalise M&E plan and conduct baseline

Finalise M&E plan and conduct baseline

Consolidate sustainability

plan and partner

relationships

Consolidate sustainability

plan and partner

relationships

Establish programme

management

Establish programme

management

Training, curriculum and

partner development

Training, curriculum and

partner development

Improved health & well-being of children

Improved health & well-being of children

Improved access to health information, guidance and social

services

Improved access to health information, guidance and social

services

Build and sustain user capacity & ownership

Build and sustain user capacity & ownership

Communicate project- roadmap,

benefits, project management

Communicate project- roadmap,

benefits, project management

Improved maternal care and emergency

response

Improved maternal care and emergency

response

Lower infectious

disease rates

Lower infectious

disease rates

Deployment activities

Develop solution based on user needs

Develop solution based on user needs

Activity tracking,

monitoring & evaluation

Activity tracking,

monitoring & evaluation

On-time and improved quality of

monitoring and reporting

On-time and improved quality of

monitoring and reporting

Design budget &

sustainable financial

model

Design budget &

sustainable financial

model

Undertake user acceptance

testing

Undertake user acceptance

testing

Train users on all aspects of

solution

Train users on all aspects of

solution

Lower child mortality ratesLower child

mortality ratesImproved

maternal healthImproved

maternal health

Millenium Development Goals

mHealth Theory of Change

Project Background

Hypothesis: mobile phone technology can improve quality of services provided by community health workersVariables:-Identification of pregnancy complications-Timely referral rates-ANC rates-Institutional delivery-Postpartum and newborn care rateMethod: register review

Information Collected

QuantitativeHow: A pregnancy and postpartum module installed on the mobile phones guided CHVs through an algorithm of danger signs, non-urgent questions, reminders, and advice to facilitate a safe pregnancy.

Data was stored in the phone and transmitted to the project’s database.Period of data collection: June 2011-October 2012QualitativeHow: two focus group discussions with CHVs participants

Information Collected

What: Quantitative Data: 750 pregnant women and 393 postpartum period

Overall complication rate of 20% (prenatal 6%, postnatal 14%)

Birth preparedness: 64% (women with complication)Referral completion: 91% (94% prenatal, 47%

postpartum)Technical support when danger sign cited : 95%

Qualitative Data: Focus Group DiscussionsConfidence in mobile device useAlgorithm supported decision-making processImproved communication with health facilityIncreased credibility

Using the Information

Who: Stakeholders National Level Partners: Mozambique Ministry Of

Health Humanitarian Partners: USAID, SCIP, Technological Partners: Commcare, Dimagi

What: use of mobile technology by CHVs associated tohigh recognition of danger signs

(prenatal/postpartum)high prevalence of birth preparednessIncreased technical support from HF with

complicated casesHow: Improved program design

Supervision approachScale-up, other applications: newborn module

Using the InformationChallenges:

PhonesLocal access to appropriate technologyDifficulties in accessing dataRegistration of SIM cards (local)Mobile phone charging

Participants:Limited literacy skillsPoor eyesightMisuse of mobile technology

Project designUtilization and accessKnowledge

Using information: solutions

Technology:Solar chargesAdequate airtime allowanceDevelopment of version II

Personnel: Training Challenges:

Reading glasses and audio promptsRefresher training

Implementation Challenges:Supervision at local level

Program DesignStrengthening communicationNewborn module

Moving Forward

Scale-Up:Increase coverage areaTwo-way referral system Newborn moduleTechnical Supervisor

Barrier Analysis: Social and Structural

Research: Experimental Design: Intervention and

Comparison Groups