Leveraging 4,000,000,000 Phones for Development: TRACnet : A Case Study from Rwanda

1. Leveraging 4,000,000,000 Phones for Development:TRACnet: A Case Study from Rwanda by Pamela Johnson, Voxiva RutonHinda, TRACplus Jean Philbert Nsengimana, Voxiva SARL Mobile Innovations for Social and Economic Transformation:From Pilots to Scaled-up ImplementationSeptember 16, 2009

2. Outline Leveraging 4,000,000,000 Phones for Development: TRACnet, A Case Study from Rwanda • Background • TRACnet • Implementing at Scale • ICT Infrastructure • Architecture and Integration • Sustaining Large-Scale Systems • Extending the Model • Rwanda • eSoko • mUbuzima • Other Countries • Conclusions

3. I. BACKGROUND: Rwanda* • Ninemillion people • GDP/capita – $ 314/ year • Health Statistics • Life expectancy • 44, males • 47, females • Immunization rate: 90% • Infant mortality rate: 86 • Maternal mortality rate: 750/100,000 live births • 517 Health Centers • Health Professionals • 401 physicians • 3593 nurses • 30,000 + Community Health Workers *www.statistics.rw.gov, UNICEF, MoH

4. II. TRACnet: Cell Phone Phone PCs/ Internet • A GoR information system that supports the national HIV/AIDS and other health programs. • Builds on existing telecommunications infrastructure • Allows TRACplus to: • Collect real-time information from the field via web, phone, mobile application, paper... • Communicate and send alerts and information back out to the field in a timely and systematic way. • View Rapid visualization of data – in charts, tables, graphs and dashboards PDA/ Smartphone Local Applications

5. COVERAGE • 2004: TRACnet launched to support national ART treatment program operating in 16 facilities • 2009: operating in all 225 ART treatment facilities in all districts • End of 2009: expansion planned to all healthfacilities nationwide 5 CORE MODULES • Patient Registry • Patient Registry • Longitudinal Patient Record • Program Indicators • ART, VCT, PMTCT • Key Performance Indicators • Analytics and management views • Inventory • Stock-level reporting • Stock-out and shortage alerts • Laboratories • Lab result reporting and access from the field. • Disease Surveillance and Outbreak Alert

6. National • As soon as data is in the system, supervisors at multiple-levels view and analyze data in real-time via a web-based dashboard. They can: • Track new reports • Map and analyze data • Track and manage people. • They can use communication tools to send alerts and broadcast messages out to the field. Disttrict Facility Sample dashboards.

7. TRACKING > 105,000 PATIENTS

8. TRACnet: Results to Date ACCESS AND USE • Widespread access - over 1,000 users at 219 facilities throughout Rwanda • > 7500 user sessions in April 2009 = > 85,000 sessions/year • Multi-channel access - using a national toll-free phone number, the web, a PC client software, and a mobile phone client • 90% facilities reporting by IVR • Access to robust and easily navigable dataset of HIV/AIDS program indicators and patient data DATA • Aggregate program indicators since 2004 from all ART facilities and patient data • > 95% routine reporting • Longitudinal data on over 105,000 patients in care and treatment TECHNOLOGY • A scaled national infrastructure - secure, access controlled, redundant infrastructure, hosted in Rwanda at a carrier grade data center and managed 24x7 • > 99% uptime • A robust enterprise architecture – built to support an evolutionary infrastructure, TRACnet leverages a standards based infrastructure and software platform, evolving into an open standards framework for scale and interoperability

9. III: Implementing at Scale • ICT Infrastructure • Architecture and Integration • Sustaining Large-scale Systems

10. a. ICT Infrastructure 2008 Coverage Super-imposed on Health Facilities 1998

11. Future Directions • Three mobile carriers • Fiber optic to be completed by 2009 (government, MTN initiatives) • Submarine cable connection • Kigali, all district hospitals connected • Site-level investments in infrastructure and data management • Support for connectivity in schools and health facilities • Current Reality: • Mobile is here • Internet is coming • You don’t have to wait

12. b. Sustaining Large-Scale Systems SIMPLE FOR THE END USER BACK-END: NOT QUITE SO SIMPLE

13. c: Architecture: Status Quo MOH TB Malaria HIV/AIDS MCH EPI Disease Surv. Donor 1 Provincial Health Authority 3k9dbns si986hs Donor 2 District Health Authority X5t6hs X5t77s 3k9dbns X5t6hs 0kb3YY Labs Donor 3 3k9dbns N7uKK0 0kb3YY X5t6hs9w X5t6hs9w Warehouse/ Distribution Center Etc NGO NGO NGO NGO NGO In Peru, health workers spend 40% of time on paperwork and admin tasks.

14. Architecture: Integrated system • Rwanda eHealth Strategy • Integrated national system of systems • Common standards, e.g. facility ID, national ID, SNOMED, etc

15. IV. Extending the Model: eSoko

16. Community Health Workers Extending the Model: mUbuzima

17. Other Countries • India • Monitoring supply chain of family planning and other commodities to the community level • Peru, Tanzania and Panama • National disease surveillance • Peru • Monitoring maternal health program • Citizen safety • Nigeria • Monitoring and evaluation of national HIV/AIDS program • Zambia • Support for patients post-circumcision • Kenya • Compliance support for patients on ART • Distribution of agricultural commodities • Mexico • Compliance support for patients on ART • Cardiovascular risk assessment and support for behavior change • Support for diabetes patients

18. V. Conclusions • Mobile is here. Internet is coming • Mobile telecommunication systems can be leveraged into large-scale enterprise information systems • Mobile can be used to support health and other development sectors • Sustaining any large scale enterprise information system requires investments in human capacity to use and maintain the system • Mobile is a tool to reach citizens with services