Enhancing Community Health Workers Performance With Mobile Technology

Dennis M. Israelski, MDPresident and CEO, InSTEDD

with support from PEPfAR,HIPPP

Source: Wall Street, 20th Century Fox, Written by Stanley Weiser and Oliver Stone, Directed by Oliver Stone, Produced by Edward Pressman, 1987

Global Cell Phone Usage

Over 1.20.901 - 1.20

.601 - .900

.301 - 600 Under .300

Cell Phones Per Person

source: World Bank, 2011 http://data.worldbank.org/indicator/IT.CEL.SETS.P2

Over 1.20.901 - 1.20

.601 - .900

.301 - 600 Under .300

87%of the global population is a mobile phone user

Cell Phones Per Person

source: World Bank, 2011 http://data.worldbank.org/indicator/IT.CEL.SETS.P2

source: CIA World Fact book 20010-11

4.5 billionusers in the developing world

87%of the global population is a mobile phone user

Ray Kurswell quote: kid in africa has more info than the pres 15 yrs ago

A kid in Africa with a smartphone today has

access to more information than the President of the United States had just

15 years ago.

source: Quote from Futurist, Ray Kurzweil, Time Magazine, March 26, 2012

smalllightweightportableconnectedinexpensivesimpleconvenientintuitiveaccessible

+

opportunity

communityCHW

performanceformal health

system

The Community Health Worker at the Intersection of Two Dynamic Systems

source: USAID Community Health Worker Evidence Summit Concept Note, 2012

countries have severe

shortages of health workers

57

are in sub-Saharan Africa

36

Countries with a Critical Shortage of Health Service Providers

(doctors, nurses and midwives)countries with critical shortage

countries without critical shortage

source: WHO, Global Atlas of Health Workforce (http://www.who.int/mediacentre/events/2006/g8summit/healthworkers_large.gif)

53%of the population of Africa

owns a mobile phone

source: World Bank, 2011

74%

of the population of Asiaowns a mobile phone53

%of the population of Africa

owns a mobile phone

source: World Bank, 2011

mobile communicationstechnologies

mHealth+ health issues+ service delivery+ decision support+ supervision+ more

mHealth:at the intersection of mobile communication

technologies and health

mHealth:the delivery of health care services via mobile communication devices

initial search strategyn = 5,868

unique citationsn = 4,667

relevant mHealth literature obtained

n = 2,603

relevant CHW & mHealth

literature obtainedn = 35

full text of potentially relevant literature

obtained n = 37

literature included in analysisn = 26

duplicate citations identified & excluded

n = 1,201

mHealth exclusions based on title,

abstract & author key wordsn = 2,064

CHW exclusions based on title, abstract & key words

n = 2,568

CHW & mHealth inclusions based on citations

n = 4

studies excused post full-text review

n = 11

Systematic Review of the Literature

Catalani, C et. al. ( Manuscript in Preparation) supported by HIPPP, PEPfAR

engineering

medical

publichealth

globaldevelopme

ntdatabases

mHealth

research areas

Catalani, C et. al.

Systematic Review of the Literature

Catalani, C et. al. ( Manuscript Submitted) supported by HIPPP, PEPfAR

Systematic Review of the Literature

Catalani, C et. al. ( Manuscript Submitted) supported by HIPPP, PEPfAR

- errors- data loss- lack of real-time QA- lack of CHW supervision - lack of rapid response- travel expenses

Mahmud N, Rodriguez J, Nesbit J. A text message-based intervention to bridge the healthcare communication gap in the rural developing world. Technology and health care : official journal of the European Society for Engineering and Medicine. 2010 Jan;18(2):137-44.

Curioso WH, Karras BT, Campos PE, Buendia C, Holmes KK, Kimball AM. Design and implementation of Cell-PREVEN: a real-time surveillance system for adverse events using cell phones in Peru. AMIA ... Annual Symposium proceedings / AMIA Symposium. AMIA Symposium. 2005 Jan;:176-80.

Bernabe-Ortiz A, Curioso WH, Gonzales MA, Evangelista W, Castagnetto JM, Carcamo CP, et al. Handheld computers for self-administered sensitive data collection: a comparative study in Peru. BMC medical informatics and decision making. 2008 Jan;8:11.

Tomlinson M, Solomon W, Singh Y, Doherty T, Chopra M, Ijumba P, et al. The use of mobile phones as a data collection tool: a report from a household survey in South Africa. BMC medical informatics and decision making. 2009 Jan;9:51.

AsiaN=5

AfricaN=9

North America

N=1

South America

N=2

mHealth

research locations

Catalani, C et. al.

mHealth

research use cases

provide decentralized services

address health issues

professional support

& supervision

provision of medical services

Catalani, C et. al.

mHealth

effective support fortask shifting

+ health system

productivity

+ human resources

- errors- costs

Catalani, C et. al.

+ fewer errors+ less data loss+ real-time review of quality+ close CHW supervision + rapid response capabilities+ cost effective

Mahmud N, Rodriguez J, Nesbit J. A text message-based intervention to bridge the healthcare communication gap in the rural developing world. Technology and health care : official journal of the European Society for Engineering and Medicine. 2010 Jan;18(2):137-44.

Curioso WH, Karras BT, Campos PE, Buendia C, Holmes KK, Kimball AM. Design and implementation of Cell-PREVEN: a real-time surveillance system for adverse events using cell phones in Peru. AMIA ... Annual Symposium proceedings / AMIA Symposium. AMIA Symposium. 2005 Jan;:176-80.

Bernabe-Ortiz A, Curioso WH, Gonzales MA, Evangelista W, Castagnetto JM, Carcamo CP, et al. Handheld computers for self-administered sensitive data collection: a comparative study in Peru. BMC medical informatics and decision making. 2008 Jan;8:11.

Tomlinson M, Solomon W, Singh Y, Doherty T, Chopra M, Ijumba P, et al. The use of mobile phones as a data collection tool: a report from a household survey in South Africa. BMC medical informatics and decision making. 2009 Jan;9:51.

small scaleindependentexploratory

non-collaborative

project E

project C

project G

project B

project H

project F

project D

project A

small scaleindependentexploratory

non-collaborative

project E

project C

project G

project B

project H

project F

project D

project A

PILOTITIS

interoperability

reusabilityscalability

sustainability

project C

project G

project B

project H

project F

project D

project E

project A

+ country leadership & ownership*+ human-centered design+ engaged end users + capacity development*+ strategic reuse*+ interoperability+ open source accessibility* + coordinating, harmonizing & sharing*+ research & evaluation*+ implementation science agenda for M&E, operations research, economic assessment & impact evaluation

Recommendations for the Future

*Greentree Principles

Caricia Catalani, DrPH, MPHInSTEDD and University of California, Berkeley*

Rebecca Braun, DrPH(c), MPHUniversity of California, Berkeley

Enhancing Community Health Workers Performance With Mobile Technology

(manuscript in preparation)

*former member

Health Informatics, Public Private Partnership

A Central OGAC Initiative

Paul Biondich, Regenstrief Institute

Dennis Israelski, InSTEDD

Chris Seebregts, Jembi, South Africa

Mike Gehron, OGAC

John Novak, USAID

Xen Santas, CDC

Chris Bailey, WHO*

Management

Team

www.instedd.org