Impact of a mHealth Intervention for Peer Health Workers on AIDS Care in Rural Uganda: A Mixed Methods Evaluation of a Cluster-Randomized Trial data sheet 994 Views
Author:
Larry W. Chang, Joseph Kagaayi, Hannah Arem, Gertrude Nakigozi, Victor Ssempijja, David Serwadda, Thomas C. Quinn, Ronald H. Gray, Robert C. Bollinger, Steven J. Reynolds
Publication Date:
Oct 2011
Publication Type:
Journal article
Abstract:
Mobile phone access in low and middle-income countries is rapidly expanding and offers an opportunity to leverage limited human resources for health. We conducted a mixed methods evaluation of a cluster-randomized trial exploratory substudy on the impact of a mHealth (mobile phone) support intervention used by community-based peer health workers (PHW) on AIDS care in rural Uganda. 29 PHWs at 10 clinics were randomized by clinic to receive the intervention or not. PHWs used phones to call and text higher level providers with patient-specific clinical information. 970 patients cared for by the PHWs were followed over a 26 month period. No significant differences were found in patients’ risk of virologic failure. Qualitative analyses found improvements in patient care and logistics and broad support for the mHealth intervention among patients, clinic staff, and PHWs. Key challenges identified included variable patient phone access, privacy concerns, and phone maintenance.
Up Close and Personal with TulaSalud's m-Health work in Guatemala data sheet 3104 Views
Mohini Bhavsar was a summer 2010 research intern at MobileActive.org. Shortly after, she volunteered with TulaSalud in Guatemala to observe what it takes to implement and scale a mobile health program.
Innovation in mobile health is not quite as widespread in Latin America as it is in Africa and Asia. Of the m-health programs in Latin America, little sharing of region-specific strategies has taken place.
TulaSalud is an organization based in Guatemala that is leveraging ICT -- specifically mobile phones -- to improve the delivery of health care services for indigenous communities. Through this case study, we hope to share some of what TulaSalud has learned over the years.
TulaSalud partners with the Ministry of Health and the Cobán School of Nursing and receives support from the Tula Foundation based in Canada. The organization's vision is to use ICT and mobile technology to reduce maternal and infant mortality and to monitor disease outbreaks in the remote highlands of Alta Verapaz. Using mobile phones, TulaSalud has been able to improve the flow of information between health professionals based in hospitals and community health workers (CHWs) in remote villages.
Alta Verapaz has the largest rural and poor indigenous population in the region with limited access to health care services. In an area with one million inhabitants, 93% are indigenous and share the highest burden of maternal mortality.
TulaSalud's community health workers, known as tele-facilitadores, use mobile phones to:
Responding to the Human Resource Crisis: Peer Health Workers, Mobile Phones, and HIV Care in Rakai, Uganda data sheet 1834 Views
Author:
Chang, L.W. et al.
Publication Date:
Jan 2008
Publication Type:
Journal article
Abstract:
Two challenges to successful antiretroviral therapy (ART) scale-up in resource-limited settings (RLS) are human resource and healthcare infrastructure limitations.
We read with interest the modeling study by Bärnighausen et al. which describes the complexities of ensuring adequate human resources to treat HIV/AIDS (HRHA). The authors suggest that factors needed to achieve universal ART coverage include “changes in the nature or organization of care,” training health workers with skills specific to the developing world to reduce emigration, and developing systems that decrease the number of traditional HRHA required to treat a fixed number of patients.
The Rakai Health Sciences Program (RHSP) PEPFAR-funded ART program has been actively pursuing innovative HIV care strategies that directly address these important points. In 2006, we piloted a novel program utilizing peer health workers (PHW) and mobile phones to monitor patients in a rural ART program in Rakai, Uganda.
In this paper, we present a phone-based application called CommCare which supports community health workers (CHWs) as they provide home-based care and social support to HIV+ and other chronic patients. We report on our experience developing and testing the application with five CHWs in Dar es salaam, Tanzania. We have developed a simple and easily useable system by rapidly prototyping CommCare with the community health workers, in quick iterations based on their feedback. The system guides the user through about 15 questions during each household visit. The CHWs answer the questions using the phone’s number pad, and the results are submitted over the cellular network to our server when the session is over.
We report on lessons learned from training and our initial deployment. We discuss the few hardware and software problems that arose during our initial piloting, most of which have been addressed. This use of CommCare has little effect on the time or efficiency of home visits, but results in much easier, much faster, and potentially more accurate reporting. In particular, it saves the CHWs approximately four hours per month spent on compiling reports in the paper system.
Finally, we conducted an initial qualitative assessment of the perception of the phone-based system by the clients of the CHWs who used it. We report on the findings below, which generally show a favorable impression of the system, including an appreciation that a phone can be more discreet than paper notebooks and that it can report data more quickly.
This guest-post is by Arturo Morosoff who completed recently a project with D-Tree International and BRAC Tanzania to provide videos on mobile phones to assist Community Health Workers (CHWs) for health education. It is posted here with permission.
I recently completed a five week volunteer project working with Irene Joseph and Gayo Mhila of D-Tree International to provide videos on mobile phones to Community Health Volunteers with BRAC Tanzania in the Mbagala district of Dar Es Salaam.
A bit about me: I have no formal training in ICT or public health. My background is in technology and business and I live and work in the San Francisco Bay Area in California. I was on a two month trip in Tanzania and volunteered to help D-Tree with this project. As such, the project needed to be completed in a short time and we began with modest goals.
Among BRAC’s programs to help alleviate poverty is its health program, which relies on an all-female team of Community Health Volunteers (CHVs) to conduct monthly home visits to provide health education and support. Each CHV visits 150 – 200 homes each month, asking health related questions and providing healthcare information. In Tanzania, D-Tree has been collaborating with BRAC to provide the CHVs with a mobile phone-based tool called Commcare, to help improve the effectiveness of their home-based programs. About a year ago there was discussion with the CHVs of providing them with health education videos suitable for use on phones to provide additional support for their home visits.
GUIDE: Getting Medical Information into the Hands of Community Health Workers data sheet 5091 Views
For community health workers who are far from medical libraries and urban centers, staying up-to-date on the latest medical advancements and disease treatments can be difficult. GUIDE, developed by AED-Satellife, is a conversion and content management system that transforms medical literature into HTML forms that are easily accessible over a mobile phone.
GUIDE currently runs on smartphones (Samsung I780) in a pilot program in Port Elizabeth, South Africa. For the last year, 50 nurses from three different branches of local hospitals have used mobiles to stay up to date on medical developments.