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Health Informatics briefings
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Informational Briefing
Futures Group eHealth and mHealth
Bobby Jefferson, Senior Health Informatics Advisor, Futures Group
Manage 36 Programmers India (10) , South Africa (10) , Kenya (10), Tanzania (2), Nigeria (1), Guatemala (1) , Uganda (2)
• U.S. Government President AIDS Relief Program $15 Billion – 10 Countries HIV, Prevention Mother to Child Transmission, TB, OVC
• Principal Investigator– National Health Informatics System (HMIS) Kenya Datawarehouse , National Electronic Medical Records 6,000 hospitals
• Lead IT Project Manager- Community Level Orphans and Vulnerable Children (OVC) electronic data system (World Vision, UNICEF, CRS, Africare) – Zambia, Tanzania
• Health IT Advisor - 5 Central Asia Republics (CAR) Consortium for AIDS Strategic Information in Central Asia (CASICA)
• Kazakhstan, Kyrgyz Republic, Tajikistan,
• Turkmenistan, Uzbekistan
Implementing eHealth and mHealth for Low Resource Communities
502 Staff
30+ countries
Multi-disciplinary
Majority doctoral and masters-level
3
Staff Profile
CHSS Geographic Focus
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Latin America and
the Caribbean: Guatemala
Guyana
Haiti
Honduras
Africa: Kenya
Lesotho*
Mozambique
Nigeria
Rwanda
Tanzania
Sierra Leone
South Africa
Swaziland
Uganda
Zambia
Zimbabwe*
Asia and the
Middle East: Afghanistan
China*
India
Pakistan*
Europe & Eurasia Georgia*
Ukraine
Informatics Solutions
• IT Database related to Poverty Reduction
– Social Cash Transfer
– Household base assistance, community empowerment,
• Mobile Surveys
• Monitoring and Evaluation system
• PPP
• Capacity Building, Knowledge Transfer,
– Site Capacity Assessment (SCA) tool
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We are working across 15 Countries, 1,033 Hospital Facilities + Satellites Clinics , Antenatal Care – 535 PMTCT sites Rural, remote, hospitals “serving poorest of poor” and Ministry of Health (MOH) facilities, Rural health facilities serving BPL, marginalized and most vulnerable populations
• Intermittent power, • Lack IT staff, • Lack internet, • Sparse mobile coverage
• Lack of referrals, or linkage between HIV, PMTCT, TB, • Cost effectiveness and sustainability -- no funds for proprietary licenses, or
yearly maintenance fees
Low Resource Environment
Results
• Internet
• Mobiles, SMS
Rural, Remote City
# of Facilities
• Sparse Mobile Coverage • No Internet
• Intermittent Power
Online Solutions
Mobile Solutions
Offline, Disconnected Solutions
• Smartphones
Nurses, Clinicians, Adherence Counselors, need health data, M&E program data in knowledge repository • Lack of referrals, or linkage between HIV, PMTCT, TB, or to existing
technology systems • Cost effectiveness and sustainability -- no funds for proprietary licenses,
or yearly maintenance fees
Low Resource Environment
Approach
Use of freely available, reusable, tools, “coded in country” Creative commons approach
Reusable software and technology across countries and programs
Offline Solutions, Disconnected model
Local programmers, all IT staff in country (India, Kenya, South Africa)
- Offer Programmer training SQL, Agile process, Virus Remediation
Low costs, Inexpensive $200-$350 Netbooks , Solar netbooks
Solar mobile phones, SMS instead of Smartphones
-
Rajketu Singh
Jayanta . Das:
Futures IT Team in India
Santosh Ghandi
Piyush Khanna,
Naveen Sharma
Sanjay Rana
Meetu Rahul
Ajay Sharma
Archana Mahawar Kanchan Verma Deepika Sain,
Collaborators and Users
ICAP Columbia University 44 sites Intra Health International 17 sites Elizabeth Glaser EGPAF 16 sites Family Health Inter FHI 45 sites Catholic Relief Services 13 sites
Catholic Relief Services - 32 Pathfinder International Gertrude Children Hospital DOD Walter Reed - 28 Mount Kenya University MOH Kenya Sites
AIDSRelief John Snow International Rakai Health Services Vaccine Research
Intra Health International
Mennonite Christian Charities AIDSRElief 35 sites
PMTCT , ANC sites 535 sites Elizabeth Glaser EGPAF
Ministry of Health Ministry of Education
Users
World Vision Clinton Foundation Columbia University UNICEF DFID
Health IT Solutions
Collectively referred to as IQSolutions
1. Electronic medical records
1. IQCare
2. Independent Technical Evaluations Performed
WHO, USAID, CDC Atlanta, CDC in-country, Ministry of
Health
2. Mobile Phone solution (IQSMS technology)
3. Visual Dashboards
4. Monitoring & Evaluation Electronic reporting
•
Clinicians able to review individual patient histories
*Clinicians review patient histories, prescribed drugs, ordered tests and results, and progress on care and treatment during the exam
demo
http://173.203.65.108/iqcare/frmLogin.aspx
Username: user1
Password: 1
Facility/Satellite: 001-01-01-Demo Site
Mobile Phone Reporting by Remote Workers
PMTCT Currently consists of 4 types of monthly reports
1. PMTCT Antenatal Clinic (ANC) Monthly Summary Form
2. PMTCT Care Register Monthly Summary Form
3. PMTCT Maternity (L&D) Monthly Summary Form
4. PMTCT Mother - Child followup SummarForm
IQSMS PMTCT Reports
Monthly and Quarterly Reports
PMTCT Report
Must Pass All Data Quality Rules, District Office
Data Quality Checks
NUMBER OF CLIENT HAD HIV TEST AT ANC
Excel
PMTCT MONTHLY REPORT PMTCT Antenatal Clinic (ANC) Monthly
Summary Form
ANC 01. New ANC clients this month
118
8 ANC 02. Previously known to be HIV
positive 17
ANC 03. Total number tasted 574 ANC 04. Number of new client had HIV test
at ANC 277
ANC 05. Tested HIV-Positive 37 ANC 06. Post-test counseled for positive
and negative 574
ANC 07. Number of partners tested for HIV 16
ANC 08. Tested HIV-Positive 4
Orphans Vulnerable Children (OVC), Most At Risk Population (MARPS), Maternal Child Health (MNH)
Ms Access Database
PDA device
Web Internet Desktop
Excel Only
M&E Electronic Reporting System Solar Power Cell phones
UNICEF Social Cash Transfer Application
Futures Group International
STEPS OVC
• STEPS OVC = Sustainability Through Economic Strengthening, Prevention and Support for Orphans and Vulnerable Children
• Program provides
– Support for HIV prevention and behavior change initiatives
– Reducing HIV transmission
– Support for OVC, at-risk youth and adults, and other vulnerable populations
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STEPS OVC Login
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STEPS OVC Beneficiary Search
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STEPS OVC Beneficiary - OVC
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STEPS OVC Reports
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ICT for Development – Best PC Security Practices
District Health Training - Mobile Phone Survey using SMS
Held Training of 600 District Health Officers in Kenya On New District Health Reporting Tool Ministry of Health NASCOP
SMS 1: Have you entered /Imported data into the new tool ? Yes or No SMS 2: Have you run reports using the new district tools ? Yes or No SMS 3: Have you discussed the new district tools and reports with other members of the district health team ? Yes or No SMS 4: In what district do you work? Your answers are confidential and a Ksh 20 refund will be given for each valid reply
Mobile Phone Survey Architecture
Assessment Database
(Excel)
Valid?
SMS Provider service
(Zain/Safaricom)
SMS archived in
frontlinesms application DB
Survey responses/corrections via SMS
FrontlineSMS Assessment Application
Survey questions and
acknowledgement via SMS
Get SMS data
Save
Yes
No
Acknowledge
(Reimburse airtime)
Request for correction
Co
nv
ert
SM
S
con
ten
t to
DB
dat
a
8 provinces involved in the survey, a total of 388 interviewees sent some reply; 101 interviewees completed the survey
Graph 1: N Participated = 165; N completed = 101
Percentage participation/completion in the DHPT text message survey by province
Table 5: Time in minutes to complete the survey
Province N =
131
Minimu
m
25th
Percentil
e
Median 75th
Percentile
Maximum Mean
Central 12 11.00 22.00 27.00 59.00 5861.00 999.33
Coast 12 5.00 9.00 27.00 54.50 969.00 106.75
Eastern North 5 15.00 17.00 25.00 30.00 31.00 23.60
Eastern South 20 3.00 9.00 18.00 480.00 9703.00 1202.10
North Rift 17 15.00 34.00 50.00 262.00 17561.00 2512.06
Nyanza 22 9.00 19.00 27.00 152.00 17534.00 1722.05
South Rift 19 2.00 15.00 35.00 1623.00 27553.00 3162.63
Western 24 4.00 768.00 1372.50 19012.50 30063.00 9424.38
Response duration and times
Graph 2: N: 131 interviewees who responded to at
least 2 questions
Median times (in minutes) participants used to
complete the SMS survey
Response duration and times
• Most of the respondents attended to the SMS after 5pm
• Sending multiple questions drastically reduces the response rate
• Re-sending an answered question does not guarantee a response
• Contact (physical, by mail or otherwise) significantly increases the response rate
• The longer the duration between a response and the next question the lower the chances of getting the next response
www.futuresgroup.com www.facebook.com/FuturesGroup www.twitter.com/FuturesGroupGbl
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