Principles for Digital Development | 2nd of 3 presentations
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Designing mHealth for Scale: Lessons Learned from Pathfinder
Marion McNabb, MPH, DrPH(c), Senior Technical Advisor, mHealth ICT4D Principles #3 Meeting - October 27, 2014
PATHFINDER mHEALTH AND MOBILE MONEY PROGRAMS
Community Health Worker Mobile
Applications and Mobile Money
Behavior Change
using SMS
Mozambique – mCenas! - Youth Focused SMS for FP and SRH
Ethiopia – m4Youth - Youth Focused SMS for FP and SRH
Tanzania – EngageTB – TB Client Self Screening and Referral
Kenya - MNCH and OVC Application, Pay for Performance
Nigeria - MNCH Application, Mobile Conditional Cash Transfer
Haiti – Integrated CHW application, Stipends with mMoney
Tanzania – MNCH, FP, HIV and Client Feedback mobile money for maternal emergencies
Vietnam – NIH RCT – SMS for Continuing Medical Education
PATHFINDER APPROACH TO MHEALTH AND MOBILE $
Scale Evidence Based Interventions Drive Quality and Performance Improvement
Integrated Service Delivery at Community and Facility Levels
-Through-
Public Private Partnerships Engaging Youth
Building the Capacity of Local Partners Generating Evidence
A mobile phone is just a means to an end, not the end in itself
MHEALTH AT PATHFINDER, CONT.
• A does not deliver a
• Ensuring sexual and reproductive health services are available and of quality is key
–What are we driving clients to?
• Mobile money implementation depends on infrastructure, adoption, users needs
• Choosing simple technologies in tech nascent environments is key to scaling
KEY CONSIDERATIONS FOR SCALING mHEALTH TOOLS
• Employ user centered design techniques
• Retrofit tools to the actual needs on the ground
• Who is your audience, what is the goal of scale?
– Vertical and horizontal scale – ideally both to achieve impact
• Analyze technology solutions through the lens of national and regional needs: integration, collaboration and coordination
• Establish public private partnerships; its essential
• Demonstrate impact before scaling interventions
CONSIDERATIONS FOR SCALING, CONT.
• Business models: MNO, Bank, Clients, Government
• No “one size fits all” scalable solution or framework. Client focused verses health workforce/systems focused mHealth interventions
– They are different!
– Who pays for scale, who OWNs the scaling process, is it holistic and framed within a health systems strengthening framework?
WHICH TECHNOLOGY SOLUTIONS FOR SCALE?
• Simple is best, go too far and you may lose interest
• Technology is 10% of the problem, the issues are rooted in health systems and governance
• Local innovators versus global tech solutions
• Open source, building on pilots, coordination among partners
• Data Storage: how and where? Cloud or local? Laws….
• Government capacity, IT/MNO infrastructure, is mHealth the top priority of the government?
• Mobile money: complex and different
– Kenya mPesa vs. Nigeria vs. Haiti
PUBLIC PRIVATE PARTNERSHIPS
• Essential and necessary. What is the motive for private sector, clients and governments? How do motives align?
• Mobile network operators and mobile money operators (banks and MNOs) have different monetary incentives. Each country is different.
• When to engage, who should engage private sector: Pathfinder/Implementers, GSMA, Banks, Donors?
• Who pays? What is the business model? What do you need to prove its worth it for governments, business and NGOs to be sustainable? Where are the international and local implementers in the scaling process?
DEMONSTRATING IMPACT WITH FRONTLINE WORKER SUPPORT TOOLS
• Generate evidence chain through the log frame
– Feasibility, acceptability, effectiveness, health outcomes
– Cost effectiveness
• Follow the chain of evidence to continually build to the base
• Research studies ongoing in Nigeria, Ethiopia, Mozambique, Haiti, Tanzania, Vietnam – CHW tools, SMS program impact
• Cost effectiveness studies: Nigeria with Brandeis and Abt, Vietnam for SMS based continuing medical education (CME)
PATHFINDER SSQH CENTRAL AND SOUTH: HAITI
Integrate mobile tools to strengthen the work of 2,500 CHWs in Haiti through the implementation of an integrated client enumeration and case management tool across all major health domains of CHW work
Objectives:
• Strengthen the quality of CHW community services
• Improve quality of community to facility referral systems and improve documentation
• Reduce reporting burden
• Strengthen ability for supervisors to conduct CHW mentoring and supervision to improve performance
• Integrate the use of Tcho Tcho mobile payments within the health sector
• Built-in care protocols • Priority scheduling of visits
driven by client needs • Targeted SMS/IVR reminders to
improve care retention • Community commodity tracking • Mapping community services
• Information feeds into HMIS
• GIS mapping of services • Data security and
confidentiality • Reports per MSPP needs
• Client referral and counter referral between ASCP and facility
• ASCP performance monitoring: driving quality improvement
ASCPs Decision Support Tool Data and Information
Facility Tool
mSante Implementation Model
HAITI, CONT.
• First Lady of Haiti committed to nationally scaling mHealth
• Pathfinder opened all apps: no need to reinvent the wheel
• Pushing technology to the edge, can it scale? Its complex when you build in referrals
• Building local capacity through NGOs – decentralize management, build supervision app, dashboard
• Human resource capacity? Can we teach local public health and technologists to manage deployments? Where does government step in? Who owns what?
NIGERIA
• Innovation Working Group/UN Foundation Award (2014-2016)
– Pilot test the use of CommCare to track beneficiaries of government-led conditional cash transfer (CCT) program and deliver payments via mobile money (mCCT)
– Co-Lead National mCCT technical working group – goal is to design and pilot for scaling nationwide
– Develop plan to expand from 5 to 1,250 sites post-award!
• Two cost effectiveness studies, dissertation research to develop costed scale up plan post pilot phase
mCCT PAYMENT WORKFLOW (3 OUT OF 9 STEPS)
Client Registration of SIM, Create mobile wallet
1 2
State SURE-P review of eligible women in CommCareHQ
3
National SURE-P approval for payment in CommCareHQ
Immediately
Health facility client registration in CommCare
NIGERIA
• Under the overall ICT4 Saving One Million Lives Initiative led by Government
• Health worker/Facility application (linking primary health centers to hospitals for referrals), client education and receipt of mobile payments and government administration through dashboard
• Government has the money for CCT implementation: delays and need for capacity building
• Mobile money at scale in Nigeria (over 18 mobile money operators) – issuing client sim cards a challange
• HMIS Reporting on the app itself
LEARNING TO TAKE COMPLEX MHEALTH SOLUTIONS TO SCALE
• Nigeria: Costed scale up plan by mid next year, what frameworks and tools to use to support government
• Haiti: Real life deployment of complex solutions, decentralized ownership and management; supporting local NGOs and International NGOs to use the tools
• Pushing the edge of innovation; simple solutions vs complex solutions at scale
• Importance of PPPs and government ownership of scaling and maintaining
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