The Use of Mobile Phones to Improve Quality

1. The Use of Mobile Phones to Improve Quality Bringing evidence-based medicine to frontline health workers worldwide www.d-tree.org

2. Who we are • What we do • Our work with Pathfinder • Our other work

3. Who we are

4. OurVision . . . . . . is to support health workers deliver high quality care using evidence based protocols running on mobile phones Who we are . . . is a world in which every person has access to high quality healthcare Our Mission . . .

5. Who we are Facing Challenges of • Front line health workers in clinics and the community with limited training, minimal supervision and high turnover • Limited (or no) data about what is being done and what are the problems • The need to reinforce training and assist our partners in monitoring and managing the work that is done in remote locations

6. Develop or adapt clinical protocols that enable task shifting Validate protocol effectiveness to ensure quality of care Design open-source software to support scale up and correct use of protocols Improve decision making by making data available at and across points of care What we do

7. How sick? very □ mild □ well □ Symptoms fever □ RR > 40/50 or chest indrawing □ diarrhea □ abd. pain □ rash □ Emergency? unconscious □ bleeding □ seizure □ other □ next  next  Treat Fever NOW Symptoms REFER URGENTLY getting sicker □ neck stiff/headache □ ear pain □ urine cloudy or pain □ sore throat □ no source found □ ampicillin 500 mg+ ALu 1 tab+ paracetemol 1 tab+ fluids next  next  1. Develop or adapt clinical protocols   Bringing evidence-based medicine to frontline health workers worldwide next  

8. AIDS study: South Africa 2. Validate protocol effectiveness = evidence base Mitchell, M, “Improving Care – Improving Access: The Use of Electronic Decision Support in AIDS patients in South Africa” Int. J. Healthcare Technology and Management, Vol. 10, No. 3, 2009

9. 3. Design open-source software to support scale up and correct use of protocols

10. 4. Electronic Medical Record running on phone Performance Report patient database patients lost to f/u 1. ali samuel 2. ben hasan 3. etc. Clinical Protocol Enable continuum of care • growth monitoring • immunizations • lab tests • pregnancy registration • referral tracking

11. Our process What we do Training + Pilot prep Field Refinement Design Assessment Pilot

12. Our Work with Pathfinder International in Tanzania

13. Our Work with Pathfinder CommCare Registration of new clients Follow –up of existing clients Issuing referrals to existing clients Reminders to complete pending referrals Currently about 150 HBCP using phones

14. Our Work with Pathfinder

15. Our Work with Pathfinder SMS alerts for missed clients

16. Summary by provider Our Work with Pathfinder Reports

17. Our Work with Pathfinder Reports Home based care monthly summary report

18. Our Work with Pathfinder Family Planning Counseling

20. BCS algorithm continued

21. Decision tree representation

22. Text and logic outlined

23. Programmed using J2ME/Xform

24. What the HW sees on phone

25. Other work by D-tree International neonatal antenatal and postnatal care

26. Other work by D-tree International provider adherence patient adherence correct assessment and treatment of patient correct treatment instructions and advice understanding of treatment instructions and advice correct treatment and care given positive health outcome eIMCI •  new protocols •  on phone •  safety study • adherence + • communications

27. Other work by D-tree International Nutrition     

28. Other work by D-tree International Assist CRS - Malawi with 1) Child Status Index (for OVC) 2) Tracking tool for PLWHA 3) C-IMCI

29. Other work by D-tree International that triage patients: - to see a physician, or - to continue on their current medications. AIDS study: South Africa Can we reduce the workload of physicians and increase access to high quality care for HIV+ patients using screening protocols Task Shifting

30. Other work by D-tree International Obstetric Plan B • Can we reduce the 3 delays of • Home Births through: • phone based protocols • mPesa to pay transportation and fees • cell numbers of vehicles for hire in emergency • recorded permissions for emergency transfer • SMS or phone call to receiving hospital

31. MNCH care in Bihar patient record data base (open MRS) patient record data base (other) Community Protocols nutrition ANC postnatal neonatal Clinic Protocols nutrition ANC postnatal neonatal reports management surveillance alerts - patient - clinic -management

32. reproductive health chronic disease child health preventive care • HIV/AIDS • Diabetes • Hypertension • TB • antenatal • family plan. • labor + del. • emergency obstetrics • IMCI • malaria • newborn • HIV/AIDS • nutrition • antenatal • immunizations • care and support

33. D-tree International Continuum of Care Neonatal Infant Care Child Dev. + Nutrition Adolescent Life Skills + Health Antenatal Labor + Delivery Post Natal Parenting Skills Family Planning • develop / refine defined quality standards • develop phone based delivery of standards to improve use • monitoring tools of standards use for supervision • patient data for quality improvement and links among providers • data links to HMIS/DHIS for supervisors + managers D-tree Activites

34. With funding from: CRS CARE Bill and Melinda Gates Foundation UNICEF National Institutes of Health The UN Foundation The World Health Organization The Swiss Tropical Institute The Rockefeller Foundation International Development Research Ctr. Harvard University Program on AIDS Microsoft Research Pathfinder International Centers for Disease Control

35. The Use of Mobile Phones to Improve Quality Bringing evidence-based medicine to frontline health workers worldwide www.d-tree.org