Enhancing Community Health Workers Performance With Mobile Technology

1. Enhancing Community Health Workers Performance With Mobile Technology Dennis M. Israelski, MD President and CEO, InSTEDD with support from PEPfAR,HIPPP

2. Source: Wall Street, 20th Century Fox, Written by Stanley Weiser and Oliver Stone, Directed by Oliver Stone, Produced by Edward Pressman, 1987

3. Global Cell Phone Usage Cell Phones Per Person Over 1.20 .901 - 1.20 .601 - .900 .301 - 600 Under .300 source: World Bank, 2011 http://data.worldbank.org/indicator/IT.CEL.SETS.P2

4. 87% of the global population is a mobile phone user Cell Phones Per Person Over 1.20 .901 - 1.20 .601 - .900 .301 - 600 Under .300 source: World Bank, 2011 http://data.worldbank.org/indicator/IT.CEL.SETS.P2

5. 87% of the global population is a mobile phone user 4.5 billion users in the developing world source: CIA World Fact book 20010-11

6. A kid in Africa with a smartphone today has access to more information than the President of the United States had just 15 years ago. Ray Kurswell quote: kid in africa has more info than the pres 15 yrs ago source: Quote from Futurist, Ray Kurzweil, Time Magazine, March 26, 2012

7. small lightweight portable connected inexpensive simple convenient intuitive accessible + opportunity

9. The Community Health Worker at the Intersection of Two Dynamic Systems CHW performance formal health system community source: USAID Community Health Worker Evidence Summit Concept Note, 2012

10. 57 countries have severe shortages of health workers

11. 36 are in sub-Saharan Africa

12. Countries with a Critical Shortage of Health Service Providers (doctors, nurses and midwives) countries with critical shortage countries without critical shortage source: WHO, Global Atlas of Health Workforce (http://www.who.int/mediacentre/events/2006/g8summit/healthworkers_large.gif)

13. 53% of the population of Africa owns a mobile phone source: World Bank, 2011

14. 74% 53% of the population of Asia owns a mobile phone of the population of Africa owns a mobile phone source: World Bank, 2011

15. mHealth: at the intersection of mobile communication technologies and health + health issues + service delivery + decision support + supervision + more mobile communications technologies mHealth

16. mHealth: the delivery of health care services via mobile communication devices

17. Systematic Review of the Literature initial search strategy n = 5,868 duplicate citations identified & excluded n = 1,201 unique citations n = 4,667 mHealth exclusions based on title, abstract & author key words n = 2,064 relevant mHealth literature obtained n = 2,603 CHW exclusions based on title, abstract & key words n = 2,568 relevant CHW & mHealth literature obtained n = 35 CHW & mHealth inclusions based on citations n = 4 full text of potentially relevant literature obtained n = 37 studies excused post full-text review n = 11 literature included in analysis n = 26 Catalani, C et. al. ( Manuscript in Preparation) supported by HIPPP, PEPfAR

18. medical engineering mHealth research areas global development databases public health Catalani, C et. al.

19. Systematic Review of the Literature Catalani, C et. al. ( Manuscript Submitted) supported by HIPPP, PEPfAR

20. Systematic Review of the Literature Catalani, C et. al. ( Manuscript Submitted) supported by HIPPP, PEPfAR

21. - errors - data loss - lack of real-time QA - lack of CHW supervision - lack of rapid response - travel expenses Mahmud N, Rodriguez J, Nesbit J. A text message-based intervention to bridge the healthcare communication gap in the rural developing world. Technology and health care : official journal of the European Society for Engineering and Medicine. 2010 Jan;18(2):137-44. Curioso WH, Karras BT, Campos PE, Buendia C, Holmes KK, Kimball AM. Design and implementation of Cell-PREVEN: a real-time surveillance system for adverse events using cell phones in Peru. AMIA ... Annual Symposium proceedings / AMIA Symposium. AMIA Symposium. 2005 Jan;:176-80. Bernabe-Ortiz A, Curioso WH, Gonzales MA, Evangelista W, Castagnetto JM, Carcamo CP, et al. Handheld computers for self-administered sensitive data collection: a comparative study in Peru. BMC medical informatics and decision making. 2008 Jan;8:11. Tomlinson M, Solomon W, Singh Y, Doherty T, Chopra M, Ijumba P, et al. The use of mobile phones as a data collection tool: a report from a household survey in South Africa. BMC medical informatics and decision making. 2009 Jan;9:51.

22. Africa N=9 Asia N=5 mHealth research locations South America N=2 North America N=1 Catalani, C et. al.

23. address health issues provide decentralized services mHealth research use cases provision of medical services professional support & supervision Catalani, C et. al.

24. + human resources + health system productivity mHealth effective support for task shifting - costs - errors Catalani, C et. al.

25. + fewer errors + less data loss + real-time review of quality + close CHW supervision + rapid response capabilities + cost effective Mahmud N, Rodriguez J, Nesbit J. A text message-based intervention to bridge the healthcare communication gap in the rural developing world. Technology and health care : official journal of the European Society for Engineering and Medicine. 2010 Jan;18(2):137-44. Curioso WH, Karras BT, Campos PE, Buendia C, Holmes KK, Kimball AM. Design and implementation of Cell-PREVEN: a real-time surveillance system for adverse events using cell phones in Peru. AMIA ... Annual Symposium proceedings / AMIA Symposium. AMIA Symposium. 2005 Jan;:176-80. Bernabe-Ortiz A, Curioso WH, Gonzales MA, Evangelista W, Castagnetto JM, Carcamo CP, et al. Handheld computers for self-administered sensitive data collection: a comparative study in Peru. BMC medical informatics and decision making. 2008 Jan;8:11. Tomlinson M, Solomon W, Singh Y, Doherty T, Chopra M, Ijumba P, et al. The use of mobile phones as a data collection tool: a report from a household survey in South Africa. BMC medical informatics and decision making. 2009 Jan;9:51.

26. project A project H project B small scale independent exploratory non-collaborative project G project C project F project D project E

27. project A project H project B small scale independent exploratory non-collaborative PILOTITIS project G project C project F project D project E

29. project A project H project B interoperability reusability scalability sustainability project G project C project F project D project E

30. Recommendations for the Future + country leadership & ownership* + human-centered design + engaged end users + capacity development* + strategic reuse* + interoperability + open source accessibility* + coordinating, harmonizing & sharing* + research & evaluation* + implementation science agenda for M&E, operations research, economic assessment & impact evaluation *Greentree Principles

31. Caricia Catalani, DrPH, MPHInSTEDD and University of California, Berkeley* Rebecca Braun, DrPH(c), MPHUniversity of California, Berkeley Enhancing Community Health Workers Performance With Mobile Technology (manuscript in preparation)

32. Health Informatics, Public Private Partnership Management Team Paul Biondich, Regenstrief Institute Dennis Israelski, InSTEDD Chris Seebregts, Jembi, South Africa Mike Gehron, OGAC John Novak, USAID Xen Santas, CDC Chris Bailey, WHO* A Central OGAC Initiative *former member

33. www.instedd.org