MobiHealth: Developing Health Service Networks through Mobile Solutions in Low Resource Settings

1. MobiHealth:Developing Health Service Networks through Mobile Solutions in Low Resource Settings

2. Program for the MobiHealth developers workshop Monday 9-9:30 Welcome, practical information 9:30-12 MobiHealth status and aims 12-13 DHIS2 13-14 Lunch 14-15 DHIS2 developing tools and processes 15-16 DHIS2 Community module 16-18 DHIS Mobile solutions Gathering at Kristin�s place

3. Program for the MobiHealth kick-off workshop Tuesday 9- 11: Mobile landscape 11- 12: Community requirements 12-13: DHISmobile tracker 13-14 Lunch 14-18 Use case Punjab

4. Program for the MobiHealth developers workshop Wednesday 9-11 Vital Events 11-13 IDSR 13-14 Lunch 14-16 Other solutions 16-18 Country implementations

5. Program for the MobiHealth kick-off workshop Thursday 9-13 Roadmap - where?/when? 13-14 Lunch 14-18 Country implementation planning Friday 9-13 Development & Implementation - organization & process Dinner/Social event

6. Mobile Phones in Low Resource Settings Low-resource settings Limited /Weak/Slow wireless networks Price Sensitivity of phones Lack of Electricity and other infrastructure Low Technology Skills Mobile phones Limited processing power Small screen size Limited visualization Limited memory However Greater Market Penetration: Small Learning Curve: Low Power Consumption: Low cost of device:

7. MobiHealth: Developing Health Service Networks through Mobile Solutions in Low Resource Settings The main objective of MobiHealth is to develop new knowledge on how to build sustainable health service networks through mobile technology in low-resource settings

8. Sub goals Explore how mobile solutions can address data processing needs in low resource setting where there is no Internet or computers. Finding ways of utilizing mobile technology for bridging the gap of the digital divide in areas with no computers and Internet. Understanding and reinforcing the social networks at the village and district levels.

9. Sub goals continue Building generic, mobile phone software which can be localized to countries and customized to health programms. Cultivate and expand a research-and practice-oriented network of excellence around health information infrastructures across countries and practices.

10. Social Networks Mobile phones provide rich potential to strengthen social networks, comprising the field level nurses, community health workers, the medical doctors and the rural population seeking health care services. Health service networks refer to the multitude of vertical and horizontal ties between health workers, possibly also clients, in low-resource environments. Given the existing insufficient support of such networks, we investigate to what extent and in which ways health service networks can be enhanced through the use of mobile technology. Understanding the dynamics of power relations

11. DHISmobile applications Typology of solutions Based on cost, network, devices, etc The suite of health applications that will be piloted on the mobile phones in the different countries include: Reporting of aggregated data from various programs Name based tracking system - DHIS tracker Generic software on a mobile platform that can support different reporting needs from different health programs with the ability to automatically generate aggregated data to the national health management information system (DHIS).

12. DHISmobile: Mobile phones for data exchange and communication Mobile-based data reporting with seamless integration with DHIS HMIS monthly reports sent from facilities at the lowest level where no computers nor Internet exist Closed User Groups to supportsocial networking Pilots in five states in India with one block selected in each state Nigeria pilots in the states Katsina and Kano Full scale in the state of Punjab, India

13. Patienr based aggregatedPatienr based aggregated

14. mHealth reference typology

15. Evolutionary perspective on mHealth Through an action oriented� research approach we focus on the need for installed base cultivation� based on available resources , as well as creating room for local improvisation and bricolage� in a dynamic development context. Based on our experiences we presents a reference typology for navigating in the space of mHealth solutions in low-resource settings. Installed base = whatever is already in place; health worker, paper registers health facilities; computers, data analysts; servers, monitoring & evaluation officers at the state level; communication infrastructures; charging facilities, technical support network coverage. installed base cultivation recognize the lack of control any one stakeholder have over the full ensemble and sees the opportunities and choices of the present as shaped and determined by the materiality and institutionalization of previously stabilized alignments. bricolage for understanding the nitty-gritty socio-technical patchworkInstalled base = whatever is already in place; health worker, paper registers health facilities; computers, data analysts; servers, monitoring & evaluation officers at the state level; communication infrastructures; charging facilities, technical support network coverage. installed base cultivation recognize the lack of control any one stakeholder have over the full ensemble and sees the opportunities and choices of the present as shaped and determined by the materiality and institutionalization of previously stabilized alignments. bricolage for understanding the nitty-gritty socio-technical patchwork

16. The importance of mobile phones to developing countries Developing countries represent the fastest growing mobile markets in the world For people with no computer access, a mobile will be their first computing device India: Mobile penetration 63% with 752 million mobile connection as of Feb 2011 15 million new mobile users per month while 14 million new Internet users for a whole year

17. Low-end mobile phones for low resource settings Limited /Weak/Slow wireless networks Price Sensitivity of phones Lack or instability of electricity Low Technology Skills No computers / No Internet Extensive rollout of mobile telecom infrastructures Widespread domestication of affordable and robust handsets Small learning curve Local competencies on servicing low-end handsets Focus on scalability no MAD projects?

18. Data flow As an example: Outreach health worker, compressed sms = store more information (like the discrete values entered into a form) As an example: Outreach health worker, compressed sms = store more information (like the discrete values entered into a form)

19. Social Networks Mobile phones provide rich potential to strengthen social networks, comprising the field level nurses, community health workers, the medical doctors and the rural population seeking health care services. Health service networks refer to the multitude of vertical and horizontal ties between health workers, possibly also clients, in low-resource environments. Given the existing insufficient support of such networks, we investigate to what extent and in which ways health service networks can be enhanced through the use of mobile technology. Understanding the dynamics of power relations

20. Organization

21. Health Information Systems Program HISP is a global network headed and initiated at the Department of Informatics, University of Oslo since 1994 doing interdisciplinary action research Responsible for the development of the open source District Health Information Software (DHIS2) implemented in 16 African countries and India, Bangladesh and Vietnam National standard for intra state HMIS in India. Implemented in 21 states Health Information Software (DHIS) is developed, customized and used for reporting, analysis and presentation of aggregated health at all levels catering for the various programs (HIV, ANC, Malaria, EPI etc) WHO is adopting DHIS as part of their standard DHISmobile where no computers nor Internet exist since 2009