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Preparing for Scale-up:World Vision Sierra Leone’s Experience
in Partnering with Government and other Key Stakeholders
Allieu Bangura, Health Advisor – World Vision Sierra LeoneMagnus Mordu Conteh, MHSc, MA – World Vision IrelandMartha Newsome, MPH – World Vision International
World Vision’s mHealth PortfolioMotech Deployments Live in 8 Countries: Sierra Leone, Uganda, Zambia, Tanzania, India, Afghanistan, Indonesia, &Sri Lanka
Motech Deployments in Planning for 7 Additional Countries: Mozambique, Burundi, Niger, Ghana, Pakistan, Mauritania, Jerusalem/West Bank/Gaza
Supporting Govt Deployments In 3 Countries:Kenya, Rwanda, Cambodia
World Vision & Digital Health
Project Name: Community Management Mobile and Health Data System
Geographic Location: Mattru Jong, Bonthe, Bonthe District
Project Timing: January 2012-December 2015
Health Programming Models: Timed and Targeted Counseling (ttC)
Target Population: 22,000 households
CHWs Utilizing Mobile Solution: 207
Community Members Reached: 17,192
Sierra Leone Programme Overview
Irish AID funded Grant
Goal: To improve child and maternal survival
SCOPE & BENEFICIARIES • 5 countries:
Sierra Leone, Mauritania,
Kenya, Tanzania, Uganda• 75,250 Pregnant Women• 75,250 Children (aged 0 -
24 months)• 2000 (+) Community
Health Workers
Health System
Social/Cultural Practices
Policies
Environment Level
Programme Model
TeachersTraditional
Leaders
Religious Leaders
Community Level
Caregivers
Individuallevel
Community Health Worker programme (ttC)
Community Health Committees (COMM)
Local Level Advocacy (CVA)
National mHealth
Coordinating Committee
Civil Society Partners
Government-Led Consortium Timeline
Government of Sierra Leone
Mobile Network Operator
WV’s pre-existing partnerships within Maternal and Child
Health
Ministry of Information & Communication
Telecommunications Regulator
Government-Driven Digital Health
• Fully aligned with national strategy and policy for development and health
• Build tacit Government ownership and tangible support for national implementation
• Focus early on health information policy framework • Ensure that telecommunications regulatory frameworks and
environments are conducive to multi-stakeholder and private sector contribution
• Commit to bringing different groups “to the table” consistently over time
• Identify and leverage the talent and resources of different partners• Help create an environment of mutual transparency & build
working relationships over time
Mobile for Ebola• WV is planning to train and equip CHWs for contact
tracing and community surveillance using a mHealth application
• IFRC has sent about 2 million messages a month, advising citizens how to avoid getting infected and to seek immediate treatment if they do http://www.reuters.com/article/2014/11/05/health-ebola-leone-mobilephone-idUSL6N0SU4JC20141105
• Alongside Sierra Leone’s Open Government Initiative (OGI), Airtel & Cambridge University, IBM has implemented a system to enable citizen reporting of Ebola through both SMS and voice.
• UNFPA, WHO, MoH – has trained and equipped 300+ contact tracers with phones for tracing and surveillance.
• http://www.chwcentral.org/blog/community-health-workers-respond-ebola-outbreak-sierra-leone
Key Partners and Collaborators
Thank You!
François Laureys, IICDGlobal mHealth Forum 2014
MHealth Monitoring: Insights from practice in West-Africa
IICD in sector Health
Mali and Senegal & malaria
o WHO health system ranking: 163rd (Mali) and 59th place (Senegal)
o Malaria is on 3rd place of (fatal) illnesses in Mali and Senegal Child mortality & malaria:
98/1,000 (Mali) 65 /1,000 (Senegal)
Overall death & malaria: 42/100,000 (Senegal) 69.4/100,000 (Mali)
o Small budget, huge shortage of (professional) health staff
o Children & treatment < 24 hours: 22.5% (Mali)
15% (Senegal)
INFO-STAT/CPS, Mali – Survey on Health and
Demography Mali (EDSM-V), 2012-2013
Ma Santé project 2011/2014o Yirimandjio (Mali) 100,000
and Fatick (Senegal) 265,000 inhab.
o (Child) health monitoring through use of 300 Community Health Workers (CHWs)
o Focus on malaria (and child health)
Data collection and analysis
Communication
Case-management and referral
Disease surveillance
mHealth intervention supports:
How does it work?
Results 2011-2014 Malio 100,000 – 150,000 people reachedo 20% increase in children receiving
treatment < 24 hrso 85% CHWs use mobile appo 74% women sleep under treated bed neto 65% pregnant women take medication
Health outcome levelo 31% decrease of malaria symptoms
among pregnant womeno 35% decrease of malaria symptoms
among children < 5 years
Partners
Muso Ladamunen & RAESo Local implementation
o Health expertise
o Training and monitoring of CHWs
o Community engagement
o Lobby & advocacy
Orangeo Platform: Emerginov
o Support software development in Senegal, technical advice in Mali
o Support local lobby
o Access to new funders (PPP)
o Scaling potential (marketing)
IICDo Project coordination
o Technical capacity building
o Coaching and advice
o Partnership brokering & alignment
o Facilitation of knowledge sharing
o Monitoring & evaluation
o Lobby & advocacy (international)
Different approacheso Involvement national authorities
vs local authoritieso Driven by ‘mutuelles’ vs
communitieso Locally developed software vs
operator driven development
Engagement Policy making Ownership Sustainability
Conclusion: multistakeholder partnership strategy
o National authority involvement is capital, but requires ‘leverage’
o Community involvement is key for sustainability
o Private sector involvement contributes to standardization and quality norms
o Disengagement from private sector can occur if investments / revenues are out of balance
o Catch 22 for software development – local vs international, quick wins vs long haul, low-cost vs ‘international pricing’
o Partnership brokering and management is essential
Resources at iicd.orgICT in Health: 5 Years of learning (IICD 2013)
ICT- A Genuine Tool to reduce isolation and raise Health Awareness (IICD 2011)
Multimedia Centres for Health workers in Ghana (IICD 2011)
Connecting medical specialists in Rural Hospitals through ICT (IICD 2010)
Health Management Information Systems for Hospitals (IICD 2010)
Digital Hygiene Education and Multimedia (IICD 2010)
ICTs and Continuing Medical Education in East Africa (IICD 2009)
Adoption and Scale-up of an mHealth Initiative to enhance Early
Infant Diagnosis (EID) of HIV in Zambia
Presentation by:Kaluba K. Mataka
mHealth Project Manager, Zambia Center for Applied Health
Research and Development (ZCAHRD)
December 10-11, 2014
Background• The Human Immunodeficiency Virus (HIV)
prevalence in Zambia estimated at 14.3%
• 21% of HIV infections result from Mother-to-child
transmission (MTCT)
• Antiretroviral (ART) therapies are used to prevent
MTCT
• However, EID is critical to support early initiation
of ART in infants when prevention of MTCT fails• Dried blood spot (DBS) samples from infants are sent to a small number of
regional laboratories to be tested for HIV with polymerase chain reaction
(PCR)
• Timely sample transportation and result delivery constitute a big challenges
to developing an effective EID service in low resource settings
Background (2)
• The Zambia Ministry of Health (MOH) and partners introduced Programme
Mwana, an SMS-based text messaging system to send HIV infant test results
directly from the 3 national testing laboratories to the distant health facility of
origin within minutes instead of days
• Prior Turnaround Time
(TAT) from sample
collection to result
delivery in 10 pilot sites
was 66 daysref - Early Infant Diagnosis: System Summary (2008) – MoH & Clinton H/A Initiative
• In 2008 CHAI, ZCAHRD and UNICEF began exploring
measures to reduce lengthy HIV testing turnaround times:
Meetings with MOH and identification of groups/persons at
the ministry to spearhead this process
Identify stakeholders in EID and implementers with expertise
• CHAI (Clinton Health Access Initiative)
• ZPCT II (Zambia Prevention Care and Treatment Partnership)
• ZCAHRD (Zambia Center for Applied Health Research and
Development)
• UNICEF (United Nations Children’s fund)
• MOH (Zambia Ministry of Health)
Site and Facility selection for pilot phase based on partners
identified
Partners Identification
Partners: Aligned Interest
MOH• Focus on EID program• Central control and support for mHealth
intervention• Local ownership and direction
CHAI• Conducted
EID study in 2008
• Proposed usage of SMS printers
ZCAHRD•PMTCT capacity for quick on-site implementation
•Ability to conduct research and evaluations
UNICEF• RapidSMS
experience + technical capacity
• Funding
Locations of Pilot SitesLuapula Province:• 11 Sites• Across 3
Districts• Implementer:
UNICEF
Southern Province:• 10 sites• Across 2 Districts• Implementer:
ZCAHRD
Central Province:• 3 Site• Across 3 Districts• Implementer: CHAI &
ZPCTII
Copperbelt Province:• 3 Sites• Across 2
Districts• Implementer:
CHAI & ZPCT II
Northern Province:• 2 Sites• Across 1
District• Implementer:
CHAI & ZPCT II
North-Western Province:• 2 Sites• Across 2
Districts• Implementer:
CHAI & ZPCT II
Programme Mwana• Built on RapidSMS©, an open source framework
• System is free of charge to the end users and is available
across the two major networks in the country
• Programme Mwana main features:
Results 160
• Designed for Health workers
• Delivers infant HIV lab results to Facilities via SMS
• Tracks samples through logistics system
RemindMi
• Designed for Community health workers
• Patient follow up• Patient tracing• Birth registration
Web Management Tool
• Manages Program• Monitors compliance• Full program
statistics, reports, charts, alerts, message boards
• National, provincial, district and partner level
From Pilot to scale
MOH approved Pilot ProposalOnsite system development
supported by UNICEF Publication of pilot evaluation (WHO bul.)
Recommendation to scale and National Launch
2009 – 10
Jul ‘10 – Feb ‘11
May‘11 Nov ‘11
Mar ‘12
* National Scale-up activities for Programme Mwana commenced in 2012 beginning with 200 sites
Govt. Ownership
• mHealth platform
• Identification of key staff
• Scale-up in non-partner supported sites
Partnership
• Implementation in partner’s supported sites
• Coordination of efforts
Govt.
Leadership
• Aligning mHealth as a strategic priority
• Inclusion in ICT policies
• Inclusion in 2015 activities (budget)
• Involved in entire system process
Enabling environment
• Feedback and reporting
• Inclusion in PMTCT, Pediatric/HIV TWGs; provincial, partner and district Data review meetings
• Creation of mHealth TWGs
Critical success factors
Coordination• Provided through leadership of MOH & UNICEF
• Use of both international and local software developers
Collaboration of development teams
• Provision of system on two major networksCollaboration with
mobile service providers
• To coordinate and oversee all mHealth activities Creation of the mHealth TWG
• Based on lessons learnt from pilot and scale-up phasesRefinement of system
• Creation of national training materials based on lessons learnt
Standardization of training materials
• At partner and provincial level Training of national
master trainers
• Creation of national scale-up through mHealth TWGCoordination of scale-
up process
System Integration• System fit into already existing PMTCT and EID
programs• Translated into the 7 major languages• Standardization of registers used • Inclusion of mHealth in National eHealth strategy
Adaptability
•Reports generated by system included in national review meetings•Users receive monthly aggregated reports•Use of data to inform the management and direction of the program
System data
•Use of local developers•Access databases located in DNA PCR testing labs•System server based at MOH•Ease and duration of trainings
System•No cost to end users•Simplicity of messages•Use of personal phones
Usability
• MOH endorsed national scale up to all PMTCT/EID sites in the
country
o Partners involved in the scale-up strategy development and
adoption
• MOH established the national mHealth TWG chaired by the
ministry to oversee, manage and report back on the scale up
process
• Master trainers formed at provincial and district levels to
cascade localized training and support
• Scale up activities commenced in 2012 with 200 facilities
targeted
o Currently operating in > 730 facilities (52% coverage) across 10
provinces
Sustainability
System ImpactScale-up activities
conducted in facilities with and without
mobile network access
Availability of program data
for implementers
via the Mwana web
tool at National,
provincial, district and
partner level
Increase in DBS testing
numbers from 4829 samples
in 2010 to 11076 in
2012*
Effective usage of the blast messaging
feature for other health related issues (+7790 messages sent
out)
Transparency of data: https://mwana.moh.gov.zm
Challenges“mHealth is by no means a panacea that will solve all of the challenges we face in the Health sector”
Pilot Phase Scale-up Phase
Difficulties in establishing leadership and ownership esp. at provincial and district levels due to small number of sites running the system (limited system impact)
New structural reorganizations within the MOH leaving the mHealth TWG with no clear leadership
Initial lack of confidence in the results sent via SMS especially with Clinical officers
Partner commitment: different partners entails different scale-up approaches based on sites supported and funding
Difficult collaboration with mobile phone providers
Despite system being free to end users, contracts with mobile providers need to be serviced and sustained
Limited number of staff at facility were trained and procured facility phones posed a challenge esp. phone charging and phone repairs
challenges being experienced in sample courier processes, availability of DBS kits and Lab reagents as success of system dependent on these factors as well
Dependence of mobile network availability and seamless internet service
Next steps with mHealth in Zambia
• MCDMCH (Ministry of Community Development Mother and Child Health) is scaling up Option B+ in Zambia and this offers up new creative and innovative way to use Mwana:o Adherence o Mentorshipo Communityo Patient follow up
• Other possible system modules for inclusiono Disease Surveillance moduleo Stock module to address issues related to stock management
• Working closely with the ministries to further enhance partnerships with the mobile providerso Bring on board 3rd mobile provider
Thank YouContributors: Judith Nguimfack, Corrie Haley, Jill Berkowitz, Kebby Musokotwane & Donald Thea
Funders: CDC, Bill & Melinda Gates Foundation, Johnson & Johnson, USAID, Global Fund
Government through: MOH & MCDMCH
Partners: UNICEF, CHAI, CHAZ, CIDRZ, ZCAHRD & ZPCTII
Creating Scale Through Strong
Partnerships: How It Is Done
Presented by Marc Olsen, Co-ChairmanmHealth Summit - December 2014
Page 43
My Talking Points
I. Why Partnerships Matter
II. Formula to Find Partner Success
III. Setting Your Filters
IV. How to Find a Winning Combination
V. What I’ve Learned – Final Takeaways
2014 mHealth Summit
Page 44
Why You Can’t Go It Alone
Why Partnerships Are Important To Fix Problems:• Jan 2013: Project delays from national election • Aug 2013: Ministry turnover and problems with leadership gaps• Oct 2013: Hardware disappearance • Jan 2014: National strike by health workers • Ongoing: Decentralization of national government
Nuts & Bolts of Kilifi Kids:• NGO operating in mHealth since 2009• Focus on ANC & immunizations; solution centers on health workers• Multiple sites in Kenya with 500 CHWs & 11 C.U.s • “Out-of-box” solution: Goal of 12 sites covering 1 million in next years
2014 mHealth Summit
1. Government
2. Funding
3. Technical
4. Community
Formula for Partnerships
Required Ingredients: To Create Scale:
1. Industry
2. Suppliers
3. Research
4. Collaborative
Page 45 2014 mHealth Summit
Setting Your Filters – Know Yourself
Step #2 – Setting Criteria that is Right for You:
Questions that we ask when evaluating potential partners for fit (besides normal due diligence on experience, track record, reputation, etc):
1. Can they fill a specific or strategic gap of mine? (Ex: sustainability)2. Where do our mutual interests lie?3. What will the cost be for all parties? 4. What is needed to build trust?5. Does this benefit the people I want to help? (Ex: private bank)
Step #1 - Understand Your Gaps:
1. Understand what state you are driving towards (need numbers)2. Determine your short fallings (KK: technology)3. Determine your commitment level (KK: research low initially)4. Create a timeline for your development
Page 46 2014 mHealth Summit
Assessing Fit – Much Like Investing
Identification - Find Partners Who Share Your Vision:
1. Can never talk to too many people, but don’t waste others’ time2. Look for partners in unusual places (personal network is underrated)3. Create a culture where every team member is a partner-maker
Process - Treat It like a Business:
1. Shop around— Recognize that most will not advance through your filters
2. Set costs for all parties to ensure buy-in3. Negotiate clear terms and create MOU, even if
strong trust already exists4. Evaluate regularly if worth continual investment
Page 47 2014 mHealth Summit
Assessing Fit – Much Like Investing (2)
Manage Expectations:
1. Can’t over communicate to core partners; need to spell out type and frequency
2. Regular reporting is not a choice; accountability of each actor keeps project on track
3. Transparency is necessary and easier than ever (Ex: finances)
Scale Quickly:
4. Thinking big is a requirement; all partners must agree to growth5. Once model is proven & trust built with the right partners, seek to
expand ferociously
Page 48 2014 mHealth Summit
What I’ve Learned
1. Make sure you have all your bases covered – Fill gaps with partners who can spread risk and bring resources (Never stop looking; “stock your bench full”)
2. Document everything – It doesn’t exist if not written down; Minimum: (1) internal selection criteria and (2) MOU
3. Be patient – Great partners are worth the wait (sometimes years)
4. Keep tomorrow in mind – Set game plan for partner growth
Page 49 2014 mHealth Summit
