Programme Mwana 2 Leveraging Mobile Technology to Strengthen Health Services for Women and Children in Rural and Underserved Areas
Feb 23, 2016
Programme Mwana2
Leveraging Mobile Technology to Strengthen Health Services for Women and Children in Rural and
Underserved Areas
Mobile health technology has the power and potential to make PMTCT more efficient and effective
The ProblemOverburdened health system and difficult to reach areas
The InnovationStrengthen entire PMTCT system using mobile technology
How Programme Mwana improves thisNow: Decrease turnaround time for PCR test results, increase number of results, enable real-time problem-solvingFuture: Track women and children to ensure that all individuals living with HIV are tested, enrolled in care, and treated
There are huge challenges implementing programs and tracking progress in line with the Global Plan and MDGs
The Global Plan seeks to eliminate vertical transmission by 2015Reduce new HIV infections among children by 90% & AIDS-related maternal deaths by 50%
However, we have no way to accurately identify the number of children currently infected
Using current methods, we will not know if we have reached the MDGs until the date has passed
Current monitoring: expensive, labor intensive, retrospective, one-way information flow
Failure to identify and enroll children living with HIV on treatment is a critical gap in the PMTCT cascade; many of these are in remote areas where UNICEF works
0.0
10.0
20.0
30.0
40.0
50.0
60.0
70.0
80.0
90.0
100.0 ANC
MaternalHIV Test
Maternal ARVs
Institutional Delivery
Infant ARVs
Infant HIV Test
* Median of 22 PMTCT priority countries
Source: Global HIV/AIDS Response: Epidemic update and health sector progress towards Universal Access, 2011
Treatment
EID
?
Although Early Infant Diagnosis (EID) is a critical part of elimination efforts, many think that it is an intractable problem
Challenges with EID• Do not know true transmission
rates in countries• Lengthy transport of samples to the
central labs• Long distances that mothers have
to travel for multiple visits• Long turnaround times• Do not know whether mothers
receive results
Other approaches have failed• PCR turnaround time has been the
focus, but turnaround time is not enough
• No cohort data, only cross-sectional so hard to know longer-term results
• Faster results do not necessarily mean that infants are being treated
• Lack of community interaction• Point-of-care solutions are far away
from being implemented
Mwana is the response to that is faster, cost-effective, and approaches the problem at a systems level TODAY
• Health system focused, trained Clinic Staff
• Community focused, trained Community Health Workers (CHWs)
All SMS are free to end users
Programme Mwana utilizes two main software components
To build the software for Programme Mwana we moved to rural Zambia and spent six weeks co-creating it with clinic staff
Keemba Luyaba Manungu Mazabuka Hospital
Mbaya Musuma
Monze Urban Nakambala Urban
Nameembo Nega Nega Rusangu 0
102030405060708090
100
7468 71
61
75
89
38
90
7869
4035 33 29 33 37
30 29
48
71
Turnaround Time to Caregiver, Pre- vs. Post-SMS System, Southern Prov-ince, by Facility (uncensored)
Pre-SMS (N=569) Post-SMS (N=210)
Facility
Aver
age
turn
arou
nd ti
me
(day
s)
56% improvement in Turnaround Time of results
Mwana increased results to mothers and decreased turnaround time, which translates into better health outcomes
Sidenberg et. all, Early infant diagnosis of HIV infection in Zambia through mobile phone texting of blood test results, Bulletin of the World Health Organization 2012;90:348-356
SMS (N=146) Hard Copy (N=103)0
10
20
30
40
50
60
7060
42
SMS vs. Hard Copy, Volume of Results Received, Luapula Province
Method of Result Receipt
Perc
ent
30% more results delivered using SMS
Mwana increased results to mothers and decreased turnaround time, which translates into better health outcomes
Schaefer, Nicholson, Mugala; Monitoring and Evaluation Presentation to the Zambia Ministry of Health; 2011
Health Facility
District Medical Office
Provincial Medical Office
National IT Management
Team
Implementing Partner
Lab Team
Software Development Team
Secondary Support
Primary Support
A MoH Tiered Management plan allows for redundancy in accountability
Reports provide aggregated health information for the MoH
Alerts allow for real-time management of the health system
Geo-locative dashboards provide real-time information on maps
EID before Mwana was primarily an “ad hoc” system
Clinic DBS test within 2 months
PCR lab analysis
DBS result back to clinic
CHW finds mother
Mother comes back to clinic
Mother goes to ART clinic
Infant born to HIV+ mother
Physical paper system in clinic but data not utilized at district or national level
Ad hoc
Ad hoc
?
?
?
?
?
Steps in EID Cascade Previous Follow-Up/Tracking System
Ad hoc
Ad hoc
Ad hoc
Mwana addresses every step of the EID cascade to ensure timely, accurate and consistent communication and to decrease loss to follow-up
Clinic DBS test within 2 months
PCR lab analysis
DBS result back to clinic
CHW finds mother
Mother comes back to clinic
Mother goes to ART clinic
Infant born to HIV+ mother
Steps in EID Cascade Mwana Follow-Up/Tracking System
DBS sample traced up to lab
CHW registers birth and is prompted at 6 weeks to remind mother to go to clinic
Result sent to all clinic staff for retrieval
Clinic can initiate TRACE on mother
CHW tells system it has TOLD mother
Potential next steps would be to add ART clinics in to Mwana – providing a complete real-time monitoring and management tool
Clinic DBS test within 2 months
PCR lab analysis
DBS result back to clinic
CHW finds mother
Mother comes back to clinic
Mother goes to ART clinic
Infant born to HIV+ mother
Steps in EID Cascade Mwana Follow-Up/Tracking System
?
DBS sample traced up to lab
CHW registers birth and is prompted at 6 weeks to remind mother to go to clinic
Result sent to all clinic staff for retrieval
Clinic can initiate TRACE on mother
CHW tells system it has TOLD mother
Next steps: FEEDBACK/VERIFY
(protocol & study design)
2010 2011 2012 2013 20140
100
200
300
400
500
600
Zambia
Num
ber o
f EID
Fac
ilitie
sMwana is scaling nationally in both countries (more sites, more women and infants served)
2010 2011 2012 2013 20140
100
200
300
400
500
600
050
100
250
450
Malawi
Num
ber o
f EID
Fac
ilitie
s
1% 10% 38% 60% 100%% NationalCoverage
% NationalCoverage
11% 22% 55% 100%
This scale up is being led by government and supported by a wide range of partners.
Government & UN
Implementing Partners
Mobile Network
Operators
Donors
Mwana is also expanding in scope across the continuum of care
Mwana as a pilot
Mwana starts scaling nationally
Mwana replicates in other countries
New modules are added
Scale across countries and continuum
Through mobile technology, Mwana has a huge potential to positively impact health systems and reach “the last mile” more quickly and effectively
Improves program outcomes and increases health impacts
Simplicity allows wide use and uptake in low-resource/rural settings
Real-time data enables real-time management & strengthened M&E
Builds on existing infrastructure, partnerships, and lessons learned
Engages communities in the process