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Using Information for Project Design: mHealth in Mozambique

Research for Improving Program Performance. Using Information for Project Design: mHealth in Mozambique. Alfonso Rosales, MD, MPH-TM Technical Specialist, Maternal and Child Health World Vision US. Project Background.

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Using Information for Project Design: mHealth in Mozambique

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  1. Research for Improving Program Performance Using Information for Project Design:mHealth in Mozambique Alfonso Rosales, MD, MPH-TMTechnical Specialist, Maternal and Child HealthWorld Vision US

  2. Project Background Location: Two administrative posts in Nicoadala District, Zambezia Province, Mozambique Maternal Mortality Rate: 490/100,000 (19th) Infant Mortality Rate: 72/1,000 (11th) Health Infrastructure: 1 provincial hospital, 5 rural hospitals 179 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

  3. mHealth Theory of Change mHealth Theory of Change Millenium Development Goals Lower child mortality rates Improved maternal health Lower infectious disease rates Natl & Intl Goals to which project contributes Improved health & well-being of children Improved maternal care and emergency response Improved prevention and treatment of disease Long-Term Outcomes to which project primarily contribute Improved efficiency and effectiveness of community case management Improved access to health information, guidance and social services Increased adherence to treatment protocols On-time and improved quality of monitoring and reporting Intermediate Outcomes Build and sustain user capacity & ownership Undertake user acceptance testing Communicate project- roadmap, benefits, project management Develop solution based on user needs Activity tracking, monitoring & evaluation Train users on all aspects of solution Deployment activities Develop Operating Plan Refine business needs & requirements Establish programmemanagement Design budget & sustainable financial model Training, curriculum and partner development Consolidate sustainability plan and partner relationships FinaliseM&E plan and conduct baseline Foundational activities

  4. Project Background Hypothesis: mobile phone technology can improve quality of services provided by community health workers Variables: • Identification of pregnancy complications • Timely referral rates • ANC rates • Institutional delivery • Postpartum and newborn care rate Method: register review

  5. Information Collected Quantitative How: 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 2012 Qualitative How: two focus group discussions with CHVs participants

  6. 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 Discussions Confidence in mobile device use Algorithm supported decision-making process Improved communication with health facility Increased credibility

  7. 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 to high recognition of danger signs (prenatal/postpartum) high prevalence of birth preparedness Increased technical support from HF with complicated cases How: Improved program design Supervision approach Scale-up, other applications: newborn module

  8. Using the Information Challenges: Phones Local access to appropriate technology Difficulties in accessing data Registration of SIM cards (local) Mobile phone charging Participants: Limited literacy skills Poor eyesight Misuse of mobile technology Project design Utilization and access Knowledge

  9. Using information: solutions Technology: Solar charges Adequate airtime allowance Development of version II Personnel: Training Challenges: Reading glasses and audio prompts Refresher training Implementation Challenges: Supervision at local level Program Design Strengthening communication Newborn module

  10. Moving Forward Scale-Up: Increase coverage area Two-way referral system Newborn module Technical Supervisor Barrier Analysis: Social and Structural Research: Experimental Design: Intervention and Comparison Groups

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