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Up Close and Personal with TulaSalud's m-Health work in Guatemala

Posted by MohiniBhavsar on Mar 09, 2011

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Up Close and Personal with TulaSalud's m-Health work in Guatemala data sheet 2747 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:

Basic Information
Website URL: 
http://www.tulasalud.org
Organization involved in the project?: 
TulaSalud
Project goals: 

In partnership with the Ministry of Health and the Coban School of Nursing and with support from the Tula Foundation in Canada, TulaSalud leverages ICT and mobile technology to reduce maternal and infant mortality and monitor disease outbreaks in the remote highlands of Alta Verapaz, Guatemala. 

Brief description of the project: 

Using mobile phones, TulaSalud has been able to improve the flow of information between health professionals in hospitals and community health workers attending to patients in remote villages.

Community health workers are using the mobiles provided by TulaSalud in the following ways:

  1. To seek remote decision-making support from physicians and specialists in urban centers
  2. To receive calls from people seeking care
  3. To organize logistics and transportation for emergencies with other tele-facilitadoras and Tula attendants at the hospitals
  4. To follow-up with Tula attendants at hospitals to ensure their referred patients received care

The NGO takes advantage of the mobile phone in these ways:

  1. Monitors disease outbreaks in real-time based on data aggregated from patient consultations using EpiSurveyor
  2. Sends text message alerts and reminders using FrontlineSMS to community workers
  3. Delivers remote health trainings via mobile phone-based audio conferencing
Target audience: 

Rural indigenous communities in Alta Verapaz, Guatemala.

Detailed Information
Length of Project (in months) : 
3
Status: 
Ongoing
What worked well? : 
  • Having strong local IT capacity.
  • Working closely with Ministry of Health, Guatemala.
  • Simple and easy-to-use forms, based on paper-forms that CHWs are already familiar with.
  • Many telefacilitators already have knowledge of community level health issues (previously trained as midwives or community health workers).
  • Telefacilitators use the calling capability of the phone to consult doctors at the TulaSalud office for diagnostic support. The mobile phone plans have 1000 minutes and network to network calling is free. This reduces costs substantially.
  • Digitizing data at the community level through the mobile phone reduced reporting time from 40 days to 4 days. 
  • Distance health training delivered by linking mobile phone to audio conferencing device.
What did not work? What were the challenges?: 
  • Signal issues in some areas required telefacilitators to walk 20-25 minutes from homes. This could be a demotivator.
  • Currently, only one physician has access to the data aggregated in EpiSurveyor. For expansion, the organization needs to develop an organized system of sharing.
  • With Episurveyor, data is downloaded manually into Excel, then to Access, where it is analyzed. This is a slow process with too many steps and is not ideal for expansion.
  • With EpiSurveyor, web-based analysis tools are weak and only for fixed form entries. All analysis is done in internal Access database.
  • There is a need to strengthen the referral processes; it is call-based and does not yet integrate with data coming through EpiSurveyor or directly with Tula's web-based records system.