MOBILE TECHNOLOGY FOR COMMUNITY HEALTH
GHANA
What is MOTECH?
Using mobile phones to
increase the quantity and
quality of maternal and child
health services in Ghana
Focus on frontline
community health facilities
(CHPS zone, Health Centre's)
and poor women in rural
areas
Maternal & Child Healthcare Challenges
In Communities
Myths & Traditional Practices
•The evil eye
•At birth hot compresses may be applied to a
baby’s skull to deliberately mold the baby’s
skull to give them a ‘special’ shape
•Colostrum is dirty
•Eating eggs or meat during pregnancy will
make the child a thief
•Giving the “welcome drink” to introduce
baby to the world
•Eating clay helps with morning sickness
Knowledge Gaps
•Dietary requirements
•Health-seeking and sanitation practices for
pregnant women and children
Maternal & Child Healthcare Challenges
For Nurses
• Volume of paper: up to 20 different
patient registers for each facility
• Onerous data reporting: nurses
spend 4-6 days per month
aggregating data
• Little information flows back to the
nurse: difficult to identify defaulters
or high risk patients
• Nurse attitudes sometimes
discourage clients from seeking
health information
• Provides weekly, relevant,
actionable pregnancy care voice
messages in local languages
 3 messages a week
 Tailored to stage of pregnancy
and first year of child’s life
 Women use their own or
household/compound phones
 Free service
• Provides maternal and child health
information and encourages better
and timely health-seeking behavior
Messages provide key MCH information for “pregnant parents” and
reminders to seek timely care:
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Personal care during pregnancy
Newborn care
Recognition of danger signs
Developmental milestones
Nutrition and breastfeeding
Malaria
Immunization
Postpartum family planning
Diarrheal diseases
Pneumonia
PROBLEM:
Too much paper,
too little useful information
SOLUTION:
Using the mobile phone for
data entry and management
CHPS Mobile Phone System
Data Entry using
Structured SMS
Automatic Reminders and
Reports
Data collection &
Reporting
• Simplified paper registers
• Nurses record patient data
onto mForms
• Upload data to central
database
• Data validation ensures high
data integrity
• Generates monthly reports
for nurses and district officials
Alerts & Reminders
• Sends alerts and reminders to
nurses and clients about
patient care
District/Region
Status of Implementation
Kassena –Nankana West District
(Upper East Region)
15
4
54
114
11,274
CHPS Compounds
Health Centers
Public Nurses trained
CHVs trained
Clients enrolled
Awutu Senya District
(Central Region)
17
5
11
127
32
12,509
CHPS Compounds
Health Centres
Maternity Homes and Private Clinics
Public Nurses trained
Private Nurses trained
Clients enrolled
District/Region
Dangbe East District
(Greater Accra Region)
Status of Implementation
Simplified Registers deployed:
13 CHPS
6 Health Centers
1 District Hospital
92 Public Nurses
Trained in mForms:
14 CHPS
2 Health Centers
South Tongu District
(Volta Region)
Simplified Registers deployed:
13 CHPS
5 Health Centers
1 District Hospital
1 Private Hospital
72 Public Nurses
West Gomoa District
(Central Region)
Simplified Registers deployed:
13 CHPS
6 Health Centers
1 District Hospital
82 Nurses
MOTECH Nurse Feedback
“MOTECH has been good because
it helps us with our reports.
Sometimes our tallying gives
us incorrect data. With the
phones we know the data that
we get at the end of the
month is correct. We used to
have to pick lots of forms in
different places and take them
elsewhere, now it’s much easier.”
CHPS Nurse
CHPS Nurse
“With MOTECH we get our clients
easily because we get messages
listing our defaulters. Some of them
also come to access services
because MOTECH sends them
messages telling them to come. We
get people coming here telling
us that MOTECH has told
them to come to the facility.”
Midwife
“Some months ago I used to get
two or three, but last month I had
ten deliveries [at the facility]
because the clients get the messages
and they come. For postnatal they
come. Even if they deliver at
home they get the messages
[from MOTECH] which make
them come for postnatal. So I have
benefited from MOTECH a lot.”
“When we see our clients for an
outreach we gather them in a big
group to educate them but we don’t
have time to do that 1:1. Often these
meetings are big and noisy so not
everyone picks up what you've said.
That's why MOTECH is good
because it provides 1:1
CHPS Nurse
information to clients along with
personalized reminder
messages”
Mobile Midwife: Client Feedback
“I liked the messages especially on the
nutrition as I was able to share with my
husband so he could hear it and now I
am allowed to get these things such as
beans, vegetables, small ground fish
for the soup and sometimes meat.”
“With MOTECH I don’t feel alone
during my pregnancy, I feel that there
are people that care for me and are
concerned about me while I am
pregnant.”
“MOTECH helps a lot with preparation for
birth. I felt like I had a good idea of
what would happen and how to
prepare practically & financially. I went
to Paga Health Center & had a safe
delivery.”
MOBILIZE SUPPLY
Simplified Register
Capture and store data more
efficiently
+
Health worker focused mobile
intervention
information to support service
delivery and continuity of care
MOBILIZE DEMAND
System effect
Phone-based health education
to pregnant women and new
mothers to increase knowledge
and awareness
Phone based alerts and
reminders
at “critical” times to promote and
encourage utilization of essential
health services
Improved
supervision and
feedback
Improve work
routine and
time for
service delivery
Increase
quantity and
improve quality
of interactions
between clients
and health
system
Aug 2010:
Pilot in KNW
District, Upper
East Region
Sept 2011:
Replication in
Awutu Senya
District, Central
Region
March 2012:
Phase II: Scale
& Transition
To date
Full implementation in 2 districts in 2 regions – Upper East, Central
Began expansion to 3 new districts in 2 new regions – Volta, Greater Accra
Approximately 23,783 clients currently enrolled (2 districts)
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100 facilities reporting (automated or enroute to automation)
469 nurses trained and using MOTECH
Integrated architecture of interoperable systems
Integrated architecture of interoperable systems and infrastructures
(paper, computers, internet, mobiles telephones
Replicated at each
administrative level:
•
National
•
Regional
•
District
Reports, GIS, Pivot, Graphs
etc
Data Warehouse
Data from/to mobile
phones
Data capture from
Paper reports
Import e data
Household
Tracking
Export e summary data
Logistics
MIS
Open LMIS
Human Resource
Records
iHRIS
Monthly summary
Reports
Medical
Records
Open MRS
Telephone
Register pregnant women
and immunization
GHS HIMS Strategy
DHIMS (Clinical
And Business
Reporting)
Aggregated Data
and Reports
Data Warehouse
For Health Care
Transactions
IHost
(Inpatient and
Outpatient Electronic
Health Records)
Data Warehouse
and Archive
Smart phones for
Service
Delivery
(Public Health Electronic
Health Records)
Other Data
Data Collection
Systems
(Surveys, etc)
Health Care Transactions and Electronic Health Records
GHS HIS STRATEGY
Transactional
Data
Data
Integration
Data
Warehousing
and Reporting
Integration Tools
DHIMS2
Clinical
Information
Systems
Community
eRegister
Other Systems
•Strong buy-in from Ghana Health Service particularly at Regional & District
levels – demand to expand the platform to include other health areas.
•Once nurses get used to the technology they embrace it and the time it
saves them for client data management
•Strong enthusiasm from community women – anecdotal “evidence” of
healthier pregnancies, increased ANC attendance, timely immunization.
•National steering committee formed and chaired by Director General of
GHS, similar platforms at Regional & District level actively leading the
program
•Proposed joint initiative to scale to an entire Region, led by GHS with TA
from Grameen
•MTN partnership: fee-based Mobile Midwife service that will cross-subsidize
the free service for poor women
Challenges Ahead
 Need for full implementation of national ehealth strategy and
leadership to:
• ensure alignment and interoperability between MOTECH and
other mhealth/ICT solutions in Ghana
• integration of the Nurses Application into DHIMS2 and eRegister
systems
 Costing/packaging MOTECH model for full integration into GHS
workplans and budgets
• Cost of airtime remains high, need for negotiation with Telcos to
bring rates down and increase network coverage
• Securing mobile phones in high volumes at low prices for nurses
 GHS resource availability to support roll out – health sector budget
already strained,
• Need to demonstrate the cost-efficiency of MOTECH vs. nonmhealth approaches for frontline data management/reporting and
getting health information to women
Questions & Answers