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 Leone
Magnus Mordu Conteh, MHSc, MA – World Vision Ireland
Martha Newsome, MPH – World Vision International
World Vision & Digital Health
World Vision’s mHealth Portfolio
Motech Deployments Live
in 8 Countries: Sierra Leone,
Uganda, Zambia, Tanzania, India,
Afghanistan, Indonesia, &
Sri Lanka
Supporting Govt
Deployments
In 3 Countries:
Kenya, Rwanda, Cambodia
Motech Deployments in
Planning for 7 Additional
Countries: Mozambique, Burundi,
Niger, Ghana, Pakistan, Mauritania,
Jerusalem/West Bank/Gaza
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
Sierra Leone Programme Overview
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
Programme Model
Local Level Advocacy (CVA)
Environment Level
Community Health Committees (COMM)
Community Level
Caregivers
Community Health Worker programme (ttC)
Health
System
Teachers
Individual
level
Traditional
Leaders
Religious
Leaders
Social/Cultural Practices
Policies
Government-Led Consortium Timeline
National
mHealth
Coordinating
Committee
Civil Society Partners
Mobile Network Operator
Government of Sierra Leone
Telecommunications Regulator
Ministry of Information &
Communication
WV’s pre-existing partnerships
within Maternal and Child
Health
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/healthebola-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-healthworkers-respond-ebola-outbreak-sierra-leone
Key Partners and Collaborators
Thank You!
MHealth Monitoring:
Insights from practice in West-Africa
François Laureys, IICD
Global mHealth Forum 2014
IICD in sector Health
Mali and Senegal & malaria
o WHO health system ranking:
163rd (Mali) and 59th place
(Senegal)
INFO-STAT/CPS, Mali – Survey on Health and
Demography Mali (EDSM-V), 2012-2013
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)
Ma Santé project 2011/2014
o 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)
mHealth intervention supports:
 Data collection and analysis
 Communication
 Case-management and referral
 Disease surveillance
How does it work?
Results 2011-2014 Mali
o 100,000 – 150,000 people reached
o 20% increase in children receiving
treatment < 24 hrs
o 85% CHWs use mobile app
o 74% women sleep under treated bed net
o 65% pregnant women take medication
Health outcome level
o 31% decrease of malaria symptoms
among pregnant women
o 35% decrease of malaria symptoms
among children < 5 years
Partners
Muso Ladamunen & RAES
o Local implementation
o Health expertise
o Training and monitoring of CHWs
o Community engagement
o Lobby & advocacy
Orange
o 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)
IICD
o 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 approaches
o Involvement national authorities
vs local authorities
o Driven by ‘mutuelles’ vs
communities
o 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, lowcost vs ‘international pricing’
o Partnership brokering and management is
essential
Resources at iicd.org
ICT 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)
Thank you!
Flaureys@iicd.org
www.iicd.org
Facebook.com/iicd.org
#IICD
December 10-11, 2014
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)
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)
•
Prior Turnaround Time
(TAT) from sample
collection to result delivery
in 10 pilot sites was 66 days
ref - Early Infant Diagnosis: System Summary (2008) – MoH & Clinton H/A
Initiative
•
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
Partners Identification
• 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: Aligned Interest
ZCAHRD
UNICEF
•PMTCT capacity for
quick on-site
implementation
•Ability to conduct
research and
evaluations
• RapidSMS
experience +
technical
capacity
• Funding
CHAI
• Conducted EID
study in 2008
• Proposed usage
of SMS printers
MOH
• Focus on EID program
• Central control and support for mHealth intervention
• Local ownership and direction
Locations of Pilot Sites
North-Western
Province:
• 2 Sites
• Across 2 Districts
• Implementer:
CHAI & ZPCT II
Copperbelt
Province:
• 3 Sites
• Across 2 Districts
• Implementer:
CHAI & ZPCT II
Luapula Province:
• 11 Sites
• Across 3 Districts
• Implementer:
UNICEF
Northern
Province:
• 2 Sites
• Across 1 District
• Implementer:
CHAI & ZPCT II
Southern Province:
• 10 sites
• Across 2 Districts
• Implementer: ZCAHRD
Central Province:
• 3 Site
• Across 3 Districts
• Implementer: CHAI &
ZPCTII
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 Proposal
Onsite system
development
supported by
UNICEF
2009 – 10
Launch of the
Pilot phase (8
Months)
Jul ‘10 –
Feb ‘11
Evaluation &
Dissemination
meeting with
MoH and
Partners
Recommendation
to scale and
National Launch
May‘11
Nov ‘11
Publication
of pilot
evaluation
(WHO bul.)
Mar ‘12
* National Scale-up activities for Programme Mwana commenced in 2012
beginning with 200 sites
Critical success factors
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
Coordination
• Provided through leadership of MOH & UNICEF
Collaboration of
development teams
Collaboration with mobile
service providers
Creation of the mHealth
TWG
• Use of both international and local software developers
• Provision of system on two major networks
• To coordinate and oversee all mHealth activities
Refinement of system
• Based on lessons learnt from pilot and scale-up phases
Standardization of
training materials
• Creation of national training materials based on lessons
learnt
Training of national
master trainers
Coordination of scale-up
process
• At partner and provincial level
• Creation of national scale-up through mHealth TWG
System Integration
•
•
•
•
Adaptability
System data
System
Usability
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
• 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
•
•
•
•
Use of local developers
Access databases located in DNA PCR testing labs
System server based at MOH
Ease and duration of trainings
• No cost to end users
• Simplicity of messages
• Use of personal phones
Sustainability
•
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
System Impact
Scale-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
o
o
o
Adherence
Mentorship
Community
Patient follow up
• Other possible system modules for inclusion
o Disease Surveillance module
o Stock module to address issues related to stock management
• Working closely with the ministries to further enhance
partnerships with the mobile providers
o Bring on board 3rd mobile provider
Thank You
Contributors: 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-Chairman
mHealth Summit - December 2014
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
Page 43
2014 mHealth Summit
Why You Can’t Go It Alone
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
Why Partnerships Are Important
•
•
•
•
•
Page 44
Jan 2013:
Aug 2013:
Oct 2013:
Jan 2014:
Ongoing:
To Fix Problems:
Project delays from national election
Ministry turnover and problems with leadership gaps
Hardware disappearance
National strike by health workers
Decentralization of national government
2014 mHealth Summit
Formula for Partnerships
Required Ingredients:
To Create Scale:
1. Government
1. Industry
2.
Funding
2.
Suppliers
3.
Technical
3.
Research
4.
Community
4.
Collaborative
Page 45
2014 mHealth Summit
Setting Your Filters – Know Yourself
Step #1 - Understand Your Gaps:
1.
2.
3.
4.
Understand what state you are driving towards (need numbers)
Determine your short fallings (KK: technology)
Determine your commitment level (KK: research low initially)
Create a timeline for your development
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.
2.
3.
4.
5.
Page 46
Can they fill a specific or strategic gap of mine? (Ex: sustainability)
Where do our mutual interests lie?
What will the cost be for all parties?
What is needed to build trust?
Does this benefit the people I want to help? (Ex: private bank)
2014 mHealth Summit
Assessing Fit – Much Like Investing
Identification - Find Partners Who Share Your Vision:
1.
2.
3.
Can never talk to too many people, but don’t waste others’ time
Look for partners in unusual places (personal network is underrated)
Create a culture where every team member is a partner-maker
Process - Treat It like a Business:
1.
2.
3.
4.
Page 47
Shop around— Recognize that most will not
advance through your filters
Set costs for all parties to ensure buy-in
Negotiate clear terms and create MOU, even if
strong trust already exists
Evaluate regularly if worth continual investment
2014 mHealth Summit
Assessing Fit – Much Like Investing (2)
Manage Expectations:
1.
2.
3.
Can’t over communicate to core partners; need to spell out type and
frequency
Regular reporting is not a choice; accountability of each actor keeps
project on track
Transparency is necessary and easier than ever (Ex: finances)
Scale Quickly:
1.
2.
Page 48
Thinking big is a requirement; all partners must agree to growth
Once model is proven & trust built with the right partners, seek to
expand ferociously
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
Thanks for your time!
More Questions:
marc.olsen@kilifikids.org