Mobile Technology for
Community Health (MoTeCH)
in Ghana
Bruce MacLeod
Jim Phillips
MoTeCH Ghana:
• Gates Foundation Learning Grant :
“Can mobile technology improve
health ?
• Columbia University, University of
Southern Maine, Grameen
Foundation, & Ghana Health
Service
• Looking for transformative
technologies that can scale to
nationwide operations and inform
global m-health strategies.
The Geographic
Context:
Sahelian West
Africa
The socioeconomic Context:
Ghana’s most
impoverished
region
In a challenging setting….
i)
…can mobile-phone-based health
information technology incrementally
improve health outcomes?
ii) …and will m-Health enhanced services
improve the quality and accessibility of
care for needs that span “the continuum
of care”
Focus:
1) Information delivered to “pregnant
parents” through “Mobile Midwives”
2) 2) Information relevant to the delivery of
health services by “Community Health
Officers” (CHOs) – part of the
“Community-based Health Planning and
Services” (CHPS) Initiative
Challenges in UER Region
Challenges in Communities
Challenges for CHPS Nurses
Problem #1: Constrained Information for Supporting
Health Service Supply and Demand
Mother’s are…
The Nurse
Dimension….
…the information
system supports
where, when, and
what outreach is
needed.
Current
Operations
Enabling supply
…the provider has
little information to
support community
outreach.
…poorly informed about …fully informed about
health care needs.
the timing and content of
care that they need.
Catalyzing
demand
MoTeCH Facilitated
Outcome
Problem #2: Different information
requirements across the “Continuum of Care”
are poorly suited to paper systems….
Pre-pregnancy
Pregnancy
Delivery
Newborn/Postnatal
Care
Childhood
Despite pervasive poverty,
the Mobile Technology Revolution has reached Africa:
• The total African mobile subscriber base has passed 500
million which is probably greater than 50% of the
population,
• Subscription in Africa is the fastest growing of any region in
the world (growing at 18%/yr)
• Over 70% of the population has access to mobile
telecommunication
• At least 15 companies have already announced plans of
introducing 3G voice and data services
• SMS (Text messages) are being used in innovative ways such
as
– Pricing information for agricultural products,
– Mobile banking
– Human rights violations
• Typically pay as you go with kiosks selling “minutes”
• “Mobile Money” is emerging as a business model.
Cell Phone coverage
The MoTeCH Approach….
First, ease information capture for community-based healthcare
workers by simplifying paper registers
MOTECH: alleviating these challenges using phones
MoTeCH Use Cases
1) Supports Nurses with an information system:
•
•
•
Data entry using Java enabled phones, (16 distinct e-forms)
Alerts/reminders for service delivery to patients (weekly)
Query for “defaulters” (2 e-forms)
2) Provides patients with health information, including:
•
•
•
•
•
Patient control of choice to enroll in the message program,
selection of optimal time of day for messaging, language .
Support for personal phones, shared phones, community phones.
Regular health messages relevant to patient needs.
Alerts for Service Delivery .
Automated answers to health queries.
3) Equips GHS & MoTeCH administrators with a medical record
system with functionality for:
•
•
•
Maintaining and updating patient data.
Providing routine reporting information for District Health
Information System.
Providing operational and supervisory reports.
Data Input on Mobile Devices
Mobile forms, openXData using xForms specification
Nurses use Java Mobile Phone App
1
2
3
Server Side MoTeCH
Requirements
• Patient Data needs to be stored :
– Service delivery, pregnancy, morbidity & immunization data; but expect more types
of data later
– Private, confidential, role based access
– Appropriate to low-income country context
• Patients sign up for health messages
– Health information, ANC & PNC appointments, ..
– Personalized, multiple languages, time preferences
• Messages need to be sent to Patients
–
–
–
–
Healthy Pregnancy information, newborn care messages
Upcoming Appointment messages
IVR to patients (2 for more info, get message with ID)
SMS (unclear if this will be useful in Upper East, Ghana)
• Nurses need to be notified of community members in need of service
–
–
SMS weekly summary of service delivery defaulters (ANC, PNC, Immunization)
SMS Immediate alert (6 hour updates) if women delivers
• Support for Telecommunication protocols
– SMS, Voice IVR, Java Forms & GPRS transmission
• Reports for District Health Information System
Over 120 Clinical & Research sites around the world
OpenMRS/MoTeCH : Secure, Web Based Access to
Registration, Message Program Enrollment, Editing
MoTeCH 1.0 Architecture
Health Policy in Ghana implements the conventional
Global “Expanded Program of Immunization” (EPI)
•
•
•
Children:
BCG (Bacillus Calmette-Guerin) - Birth
OPV (Oral Polio Vaccine) - Birth, 6 weeks, 10 weeks, and 14 weeks
PENTA (Pentavalent Vaccine, DPT-Hib-HeB) - 6 weeks, 10 weeks, and 14 weeks
Measles - 9 months
Yellow Fever - 9 months
Not to administer BCG or Yellow Fever immunization if child has HIV/AIDS
Women (12-44 years old):
TT (Tetanus Toxoid) - 5 doses Early as possible (12 years old?)
–
–
–
–
•
Minimum 4 weeks after TT1
Minimum 6 months after TT2
Minumum 1 year after TT3 or during next pregnancy (When during pregnancy?)
Minumum 1 year after TT4 or during next pregnancy
Pregnant Women
– Treated Nets in Malaria areas
– IPT (intermediate preventative treatment for malaria)
– PMTCT
The patient care schedule is
updated when new data arrives
Event/Workflow Engine :
Health Tips & Upcoming Service Delivery
Expected Service Delivery Dates are put on a Calendar :
Send Messages to Patient for Upcoming Delivery
Send Messages to Nurse when Overdue
Support Query Messages from Nurse
Specification for care schedules and messaging do
not require programming:
XML Declarative Logic for Tetanus Eligibility
•
•
•
•
•
•
•
•
•
•
•
•
•
•
•
•
<bean id="pregnancyTetanusSchedule" class="org.motechproject.server.service.impl.ExpectedObsSchedule">
<property name="name" value="TT" />
<property name="conceptName" value="TETANUS TOXOID DOSE" />
<property name="registrarBean" ref="registrarBean" />
<property name="requirements">
<list>
This Service is
<bean class="org.motechproject.server.service.impl.AliveRequirement" />
interested any
<bean class="org.motechproject.server.service.impl.AgeRequirement">
Tetanus Toxoid
<property name="minValue" value="12" />
doses in the
<property name="minPeriod" value="year" />
</bean>
OpenMRS DB
<bean class="org.motechproject.server.service.impl.GenderRequirement">
associated with
<property name="gender" value="FEMALE" />
presently living
</bean>
females, 12 years
</list>
</property>
and older.
MoTeCH Technologies & Components
(MoTeCH builds on past efforts)
• OpenMRS : Medical Record System
• OpenXData : Mobile client & form designer
• Spring Framework Application
– Hibernate, mysql, java libraries
– Maven build
•
•
•
•
Many open source libraries
CI : Continuous Integration Server
IntelliIVR : IVR system
SMS Gateway Support
Technical Next Steps
MoTeCH Ghana  MoTeCH Platform
• Improved use of Standards
– VoiceXML for IVR
– SDMX-HD for data aggregation
• Common concept dictionaries (PIH, MVP…)
• xForms  MRS
– With support for Server side validation, complex
mappings, & data can initiate program logic
•
•
•
•
IVR  MRS
Rules Engine (Drools) for scheduling messages
Large Scale Implementations
Build and Support Open Source Community
MoTeCH 2.0 Architecture
MoTeCH 2.0 Architecture
MoTeCH 2.0 Architecture
MoTeCH 2.0 Architecture
The Future:
Expanding MoTeCH Functionality over the
continuum of care….
District
Sub-district
Community
Doorstep
Postpartum +
neonatal
Pregnancy
Delivery
Post
weaning
Postneonatal
Late
childhood
Etc…..
Etc…..
Etc…..
Etc…..
Dimensions of the continuum of care…
District
At each intersection
there are unique
information needs…
Sub-district
Community
Doorstep
Postpartum +
neonatal
Pregnancy
Delivery
Post
weaning
Postneonatal
Late
childhood
Etc…..
Etc…..
Etc…..
Etc…..
Most problems that
Dimensions of the continuum
of care…
are point of service
related are solved
At each intersection by MoTeCH…but
District
there are unique
problems and needs…
Sub-district
Community
Doorstep
Postpartum +
neonatal
Pregnancy
Delivery
Post
weaning
Postneonatal
Late
childhood
Etc…..
Etc…..
Etc…..
Etc…..
Dimensions of the continuum of care…
District
Sub-district
Community
Doorstep
FamilyPlanning
ANC
&
Delivery
Postpartum +
neonatal
Post
weaning
Postneonatal
Late
childhood
Etc…..
Etc…..
Etc…..
Etc…..
..and some health
…such as
systems support
supply and logistics,
Dimensions
ofnot
thefully
continuum ofreporting
care…to the
problems are
National Health
addressed by
Insurance System,
MoTeCH…
and….
District
Sub-district
Community
Doorstep
Postpartum +
neonatal
Pregnancy
Delivery
Post
weaning
Postneonatal
Late
childhood
Etc…..
Etc…..
Etc…..
Etc…..
Other problems are
emergency
referralof care…
Dimensions
of thesupport,
continuum
and information feedback
related.
District
Sub-District
Community
Doorstep
Postpartum +
neonatal
Pregnancy
Delivery
Post
weaning
Postneonatal
Late
childhood
Etc…..
Etc…..
Etc…..
Etc…..
Other problems are
emergency
referralof care…
Dimensions
of thesupport,
continuum
and information feedback
related.
“Mobile money”
could pay a crucial
role in supporting
facility based
delivery and
emergency logistics
District
Sub-District
Community
Doorstep
Postpartum +
neonatal
Pregnancy
Delivery
Post
weaning
Postneonatal
Late
childhood
Etc…..
Etc…..
Etc…..
Etc…..
Conclusions:
MoTeCH …
• Provides an information system for nurses
Conclusions:
MoTeCH …
• Provides an information system for nurses
• Provides health information to pregnant
women and young mothers.
Conclusions:
MoTeCH …
• Provides an information system for nurses
• Provides health information to pregnant
women and young mothers
• Supports the system of care: Management,
supervision, monitoring.
Conclusions:
MoTeCH …
• Provides an information system for nurses
• Provides health information to pregnant women
and young mothers
• Supports the system of care: Management,
supervision, monitoring.
MoTeCH…
• Builds on and adds to the open-source health
information software community.
Conclusions:
MoTeCH …
• Provides an information system for nurses
• Provides health information to pregnant women
and young mothers
• Supports the system of care: Management,
supervision, monitoring.
MoTeCH…
• Builds on and adds to the open-source health
information software community.
• Supports the science of scaling up.
Thank you
www.ghsmotech.org
Feel free to contact Jim or Bruce for more information :
jfp2113@columbia.edu or macleod@usm.maine.edu