SMP Health Links Forum 14th May 2015

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mHealth in Malawi


mHealth: “using mobile communications-

such as PDAs and mobile phones- for

health services and information”



■ Education and awareness

■ Remote data collection

■ Remote monitoring

■ Communication and training for healthcare

workers

■ Disease and epidemic outbreak tracking

■ Diagnostic and treatment support


Strengths/potential:

– Growing mobile coverage/reach

– Relative affordability and access to handsets

Concerns/obstacles

– Security/privacy issues

– Relevance of apps

– Limits of existing tech systems/connectivity

– Costs to individual

– Commercial sustainability- many NGO-funded









Dial a Doc

Airtel 321

Mhealth on *567*41#


Toll free hotline

“Tips and reminders” messaging

Emergency Triage Assessment and

Treatment (ETAT) for children at

primary care using mHealthSMP Health Links Forum

Barriers to recognition and treatment of

meningitis at Primary Health Level

Primary health

level

misdiagnoses

High numbers

of patients

Erratic

consultation

systems

Unsystematic

Desmond et al 2013 PLOSone


• Negative perceptions of health services

• Low level of awareness of meningitis

• Gender and age-based decision making

in community

• Financial constraints

Barriers to seeking timely treatment for

meningitis at community level


Action Meningitis

• Improved recognition of severe illness

• Appropriate referral

Primary Health Level

Community Level

• Community recognition & awareness of

meningitis and triage system

• Initiation of timely treatment

Triage

system

Theatre

Radio

Primary Health Clinics: Blantyre

Primary Health Level Triage

system

• Severe illness regularly

missed

• Limited number of HCW,

equipment & supplies

• HCW overwhelmed

• Long queues

Primary Health Clinics: Blantyre

Aims:

1. To develop a triage system, tailored for PHCs

2. To implement this system within 5 PHCs in

Blantyre and 3 centres in Chikhwawa

3. To encourage appropriate referral decisions

to hospital & track referrals

4. To monitor, evaluate and refine this system

Implementation of Triage System

‘mHealth’ Triage Tool

• Emergency Triage, Assessment and Treatment (ETAT)

protocol developed by the WHO.

• Designed for hospital settings, in resource-poor countries.

• Specifically aimed at lower cadre staff.

Emergency

Priority

CHILD IS VERY

SICK. PRIORITY

MUST BE GIVEN IN

THE QUEUE

QueueCHILD HAS MINOR

INJURY/ILLNESS.

TO WAIT IN THE

QUEUE

CHILD IS

EXTREMELY SICK.

TO BE SEEN

IMMEDIATELY

Triage classification

‘Chipatala Robot’

Improving patient pathways

Patient

enters

PHC

HCW conducts

rapid triage

Patient assigned

E, P, Q

Clinician conducts

consultation &

enters dataAdapted from Sarah Bar-Zeev (2012)

Patient follows

clinician

instructions

PatientTriage

PHC

ClinicianQECH

Fieldworker

If referred to QECH

data entered on arrival

Bangwe clinic

Evaluation

“At Bangwe we are now working together as a

team. It is helping us manage the children so

much better. We are seeing them far more

quickly than before”

Patient Journey Modelling

• Identified positive changes in patient flows

Semi-structured interviews

• Patient and health worker satisfaction high

Medical Assistant, 2013

Summary

Next steps – three year time plan

- Optimise ETAT system in 8 centres plus benchmarking

3 new clinics.

- Provide evidence that mHealth triage can be

successfully implemented country-wide in a sustainable

and cost-effective way.

- Produce a full implementation and management

package for transference to MoH ownershipCommunity Level

.

Thank you

SMP Health Links Forum

Can Mobile Communication be used to Promote Health Promotion in the

Developing World?

14th May 2015

Department of Civil and Environmental Engineering University of Strathclyde

A bit about me…

• PhD student , University of Strathclyde, Civil and Environmental Engineering.

• Scotland Chikwawa Health Initiative, led by Dr Tracy Morse at the Polytechnic in Blantyre and Dr Tara Beattie at the University of Strathclyde.

• SCHI, primarily funded by the Scottish Government, is working in the Chikwawa district to implement the WHO Healthy Settings approach to community living.

Why mHealth?

30% of the population own a mobile phone

with a 70% increase in subscribers in the last 6 years (ITU, 2014).

94% of the country has access to adequate mobile coverage, reaching 79% of the geographical area of Malawi (GSMA, 2012).

Therefore due to wide accessibility of mobile coverage the potential for mobile communication to aid the health sector in Malawi is promising.

Advantages to Health

Recently in the news that Malawians spend 56% of their monthly income on their mobile phone, the biggest mobile phone expenditure in the world (ITU, 2014)

Advantages of mHealth:

o Quick information output to large numbers of participants

o Access to messages without restrictions on time or location

o Anonymous access to information (on their own phone)

mHealth Intervention Process

Post Intervention Measures

Implementation

Baseline Measures

Message Creation

Target Health Areas

Target Health Areas

• Focus Group Discussion for baseline data of SCHI

• Secondary Analysis for health issues

0

1

2

3

4

5

6

7

8

9

10

General Leadership Men Women Elderly Male Youth Female Youth

Fre

qu

en

cy

Sample Population

Health discussion by topic and focus group

HIV/AIDS

Family Planning

Hygiene

Malaria

Cholera

Diahorrea

Nutrition

Early Pregnancy/Marriage

Rabies

Elephantiasis

0

1

2

3

4

General Leadership Men Women Male Youth FemaleYouth

Freq

uen

cy

Sample Population

Health Education request by topic and focus group

HIV/AIDS

Family Planning

Malaria

Hygiene

Nutrition

Health Education

“…lack of health education provision was highlighted by male youth specifically the need for hand-washing.” Kalonga Village Profile

“Men requested health education on how to achieve the six food groups” Kalonga Village Profile

Youth Friendly Services

mhealth can be used to engage adolescence into health services

It won’t replace their need for support and counselling…but will improve their knowledge until such services can be put in place

“…the lack of youth friendly services was noted by male youths and is a deterrent to them accessing health education and services.”Thukuta Village Profile

Male youth in 5 of the 18 villages mentioned the need for youth friendly services

Message Creation

Based on specific health issues from focus groups and on WHO guidelines

SMS or Voice Messaging [potential for role modelling]

-Biran et al., (2014) Promoting Hand washing in rural India

-Irivine et al., (2012) SMS intervention for Disadvantaged Men

Translated into Chichewa

Piloted for cultural relevance

Design

Intervention Group

Control Group

• Baseline measures• Intervention access• Post-intervention measures

• Baseline measures• Usual healthcare services• Post-intervention measures

Implementation

Evaluation

Evaluation is key

-effectiveness of the intervention

-relevance to the people of Chikwawa

-cost-effectiveness

Are mobile health interventions feasible as a health education tool in Malawi?

Next Steps…

August-October;

Focus groups and message creation

Call for Technical Experts…

• Experience using Telerivet or similar programmes, it would be great to get some input.

David Li v ingstone Sc hol a rship

Malawi M

i

l lennium Pr oject

The M

a

l aw i Po l yt echni c

Awarded to :

Chimwemwe N. K. N diransongwe

In recognition of academic ac hi ev ement 2013-2014

Convener - Malawi Millennium Project

Principal - Kamuzu Co llege of Nursing

Rebecca LaidlawPhD StudentScotland Chikwawa Health Initiative

University of [email protected]

References

Biran, A., Schmidt, W., Varadharaian, K., S., Raiaraman, D., Kumar, R., Greenland, K., Gopalan, B., Aunger, R., & Curtis, V. (2014). Effect of behaviour-change intervention on handwashing with soap in India (SuperAmma): a cluster-randomised trial. The Lancet, 2(3), e145-e154.

Groupe Speciale Mobile Association. (2012) TNM – Malawi – Feasibility Study. Retrieved from: http://www.gsma.com/mobilefordevelopment/tnm-malawi-feasibility-study

International Telecommunications Union. (2014). Measuring the Information Society Report; Executive Summary. Retrieved from: https://www.itu.int/dms_pub/itu-d/opd/ind/D-IND-ICTOI-2014-SUM-PDF-E.pdf

International Telecommunications Union; Facts and Figures. (2014). Mobile-Broadband uptake continues to grow at double-digit rates. Retrieved from: http://www.itu.int/en/ITU-D/Statistics/Documents/facts/ICTFactsFigures2014-e.pdf

Irvine, L., Falconer, D., W., Jones, C., Ricketts, I., W., Williams, B., & Crombie, I., K. (2012). Can text messages reach the parts other process measures cannot reach: an evaluation of a behaviour change intervention delivered by mobile phone? PLOS ONE, 7(12), 1-6.

mHealth in Malawi


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SMP Health Links Forum 14th May 2015