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USAID‘s Strengthening Health Outcomes through the Private Sector (SHOPS) project seeks to increase the role of the private sector in the sustainable provision and use of quality family planning/reproductive health and other health products and services. One of the areas of technical focus of the SHOPS project is to identify, deploy, and scale up promising uses of mobile technologies to improve health outcomes. Many developing countries have a severe shortage of health providers, and many of the providers who are working have only limited access to up-to-date clinical protocols, or face-to-face trainings. Mobile phones offer an innovative channel through which to provide cost-effective approaches for clinical training and support for improving quality of care.

SHOPS‘ partners Abt Associates, Jhpiego, and Marie Stopes International (MSI), collaborated in a mobile learning and performance support pilot called Mobiles for Quality Improvement (m4QI) conducted in Uganda during the period September 2010–August 2011. The goal of m4QI was to demonstrate the potential for positive behavioral change in service delivery by reinforcing face-to-face induction training lessons provided to Marie Stopes staff. Research supports the theory that spaced reinforcement of training combined with testing can significantly improve long-term knowledge retention and facilitate behavioral change.

The objectives of m4QI were to develop and test a technology-supported approach to performance improvement including processes for identifying performance gaps in adherence to clinical protocols, a platform to manage and automate the delivery and receipt of text message reminders and quizzes to address the gaps, and production of actionable data to improve effectiveness of supportive supervision and follow-up. To support scalability and replicability, the pilot platform was designed for users of low-end phones, and those without Internet access.

Around the world, countless lives are lost due to insufficient access to quality health information. The availability of accurate, timely, and analyzed data is directly relevant to the quality of an individual’s health and the healthcare system in general, the delivery of individual care, and the understanding and management of overall health systems.

This discussion paper:

1) Examines the role ICTs, and mobile technology in particular, can play in improving access to quality health information, review the ecosystem of health information related to patients,

2) Traces the data throughout the continuum of care, examine health information flows from patients in villages to international health organizations and the most important steps in between,

3) Identifies common ground on which technologists and public health professionals can develop innovative strategies and tools to strengthen health care systems by supporting health data flows, working from the premise that better data collection will lead to better health policies and health outcomes,

4) Focuses on three healthcare domains – surveillance systems, supply chain, and human resources – and through the perspectives of experts in these domains, identify critical gaps in health information flows that technology-based solutions could address. In the case of each of these three domains, we use maternal health as an example to show how technology-backed interventions can improve health information flows,

5) Identifies barriers, choke points, and other inefficiencies to guide the discussion of how modern ICTs can improve health information flows and health outcomes in the developing world,

6) Provides recommendations for using modern ICTs to make health information flow more efficiently and perhaps even transform the process of care delivery itself.

After extensive studies of BRAC’s health services for mothers, neonates and children in rural and urban areas (MNCH and Manoshi, respectively), ClickDiagnostics has developed a mobile phone-based solution for streamlining BRAC’s data collection procedures in Manoshi, enabling BRAC to take a more pro-active approach in strategizing and reaching the women most in need in the urban slums.

ClickDiagnostics is in the concluding stages of piloting thissolution jointly with BRAC, and after the completion of the project in January, will support BRAC in refining the model and scaling up for nationwide implementation in MNCH and Manoshi projects, and possibly also in BRAC Health’s other program.

One important reason why many pregnant mothers succumb to death or preventable miscarriages is that it is expensive for government or non-government health organizations to track pregnant mothers to assess their level of risk and prioritize its limited resources for targeted intervention. A model in which community health-workers use ICT to gather real-time information about pregnant women and send to a specialist can help to address this gap and help health organizations take precautionary measures about risky cases of pregnancies.

In this paper, we present D-tree International’s work with medical algorithms and mobile applications to improve the standards of care in clinical and community settings. In particular, we present a mobile phone-based application called CommCare which helps community health workers (CHWs) to provide home-based care and social support to HIV, tuberculosis and other chronic patients. The application guides the CHWs through a series of questions which they answer using the phone’s number pad. The data then can be submitted directly to a central database over a cellular GPRS network.

We report on our experience developing and testing the application in Tanzania, including the iterative development process with the CHWs and training them to use the program. We include an account of some of the hardware and software issues encountered and resolved during the process, and some initial reactions from the first CHWs and clients to use the program. While the formal evaluation of the program is still in progress, initial findings show that the phonebased system is generally viewed positively by the users and by the clients as more discreet and better for privacy than the paper-based system.

Stock-outs of malaria treatments at the health facility level in many sub-Saharan African countries have been a persistent problem for many years. A stock-out is the unavailability of medicine at the health facility. In Tanzania, 93 % of the population are at risk for malaria infection. The number of malaria cases is estimated to be 11 million resulting into 60-80 thousand deaths per year or 220 deaths per day in Tanzania alone. The goal of the SMS for Life pilot project was to develop a flexible and scalable solution to bring up-to-date visibility of anti-malarials within the Tanzanian Public Health Sector with a potential to reduce or eliminate stock-outs of five drugs (four dosage forms of ACTs and Quinine Injectable) in all health facilities in a pilot sample of three districts.

Initiated and led by Novartis, a public-private partnership was established with the Roll Back Malaria Partnership, IBM, Vodafone and the Ministry of Health in Tanzania. This unique partnership developed a solution using mobile phones, SMS messages, internet and mapping technology to visualize weekly stock inventory of Artemisinin Combination Therapy (ACTs) and Quinine Injectable at 129 health facilities and 226 villages. Over the course of one year, the Project Team designed the system, created a data repository, trained key staff and implemented the solution for a 21-week pilot in three districts of Tanzania: Ulanga, Kigoma Rural and Lindi Rural. These districts are located in three different regions and supplied from different Zonal Stores with a catchment population of 1.2 million people.

The application of mobile computing and communication technology is rapidly expanding in the fields of health care and public health. This systematic review will summarise the evidence for the effectiveness of mobile technology interventions for improving health and health service outcomes (M-Health) around the world.

To be included in the review interventions must aim to improve or promote health or health service use and quality, employing any mobile computing and communication technology. This includes:

(1) interventions designed to improve diagnosis, investigation, treatment, monitoring and management of disease;

(2) interventions to deliver treatment or disease management programmes to patients, health promotion interventions, andinterventions designed to improve treatment compliance; and

(3) interventions to improve health care processes e.g. appointment attendance, result notification, vaccination reminders.

A comprehensive, electronic search strategy will be used to identify controlled studies, published since 1990, and indexed in MEDLINE, EMBASE, PsycINFO, Global Health, Web of Science, the Cochrane Library, or the UK NHSHealth Technology Assessment database. The search strategy will include terms (and synonyms) for the following mobile electronic devices (MEDs) and a range of compatible media: mobile phone; personal digital assistant (PDA); handheld computer (e.g. tablet PC); PDA phone (e.g. BlackBerry, Palm Pilot); Smartphone; enterprise digital assistant; portable media player (i.e. MP3 or MP4 player); handheld video game console. No terms for health or health service outcomes will be included, to ensure that all applications of mobile technology in public health and healthservices are identified.

Bibliographies of primary studies and review articles meeting the inclusion criteria will besearched manually to identify further eligible studies. Data on objective and self-reported outcomes and study quality will be independently extracted by two review authors. Where there are sufficient numbers of similar interventions, we will calculate and report pooled risk ratios or standardised mean differences using meta-analysis.

This systematic review will provide recommendations on the use of mobile computing and communication technology in health care and public health and will guide future work on intervention development and primary research in this field.

‘Aarogyam’ is a Sanskrit word which means "complete freedom from illness”. Aarogyam is an ICT based responsive system which ensures and involves active participation of all key stakeholders viz. local administration, health facilities and doctors, frontline health workers (ASHA (Accredited Social Health Activists), ANM (Auxiliary Nurse Midwife), and AWW (Angan Wadi Workers)), village heads and beneficiaries, to ensure that a pregnant woman is provided with ANC, PNC and complete immunization throughout the continuum of care.   Aarogyam maintains a village wise database of all the beneficiaries (pregnant/lactating women, children up to 5 years) of an area, which gets continually updated with new data generating on the field with the help of front line health workers. The database thus generated is the backbone of the software system used by Aarogyam. This system generates automated alerts in the form of vernacular voice calls/SMS to the beneficiary thus enabling the beneficiary with vital information at their door step.   The system not only provides beneficiary with the information to be acted upon but also ensures that the services are delivered to the beneficiary by generating automated alerts (vernacular voice calls/SMS) for the ANM and Block level health officials, informing them of due services in their area.  

At the UN Millennium Summit in September 2000, world leaders adopted the Millennium Declaration, committing nations to a new global partnership to reduce extreme poverty and address pressing challenges of hunger, gender inequality, illiteracy, and disease. The year 2015 has been affirmed as the deadline for reaching these Millennium Development Goal (MDG) targets.

The goal is to show how an integrated approach to community-level development can translate the international MDG agreements into ground-level breakthroughs throughout rural sub-Saharan Africa. Villages are located in deeply impoverished rural areas that were considered hunger hotspots—with at least 20% of children malnourished. Sites were selected to reflect a diversity of agro-ecological zones, representing a range of challenges to income, food production, disease ecology, infrastructure, and health system development.

The Millennium Villages Project is a ten-year initiative spanning two five-year phases. The first phase focuses on achieving quick wins, especially in staple crop production and disease control, and on establishing basic systems for integrated rural development that help communities escape the poverty trap and achieve the MDGs. The Project involves the coordinated community-led delivery of a locally tailored package of scientifically proven interventions for agriculture, education, health, and infrastructure. Over the first five-year phase, interventions are delivered at a modest cost, totaling approximately $120 per capita per year, of which MVP brings about half to complement funds from the host government, the local community, and other partners. The second five-year phase will focus more intensively on commercializing the gains in agriculture and continuing to improve local service delivery systems in a manner that best supports local scale-up.

This report for mHealthEd 2011 at the Mobile Health Summit focuses on the effectiveness of mHealth Education applications, analyzing at length the first wave of projects and the steps to be taken into consideration for further initiatives.

The first wave of mHealthEd applications for health workers – most introduced within the last 4 years and some of which are 7 presented in this report – include ones which enable workers to learn new treatment procedures, test their knowledge after training courses, take certification exams remotely, look up information in medical reference publications, and trade ideas on crucial diagnostic and treatment decisions. It is too early to test for impacts on health outcomes, but projects suggest that mHealthEd applications are improving the provision of care and levels of knowledge. Improved training can also increase job satisfaction and reduce attrition rates for healthcare workers.

While researchers are often depicted as either ‘social scientists’ or ‘technologists’ often their educational and ideological backgrounds are much richer than the two simple terms might imply.

This paper describes the methodology and approach of a qualitative researcher with a computer science background in investigating how information technology changes communications and information management practices within the health ecosystem constitutued by a health subsidy program in southwest Uganda.

Access to basic health  service is limited in rural areas of Bangladesh, where 80% of the total population lives. For instance, 35% of doctors and 30% of nurses are located in four metropolitan districts where only 14.5% of the population lives. Most of the rural people are physically remote from the qualified health care providers. Two major mobile phone service providers in Bangladesh have initiated mobile health care help line service s nationwide as a remedy in this case. Since there is much hope of mobile phones to be used for basic health care services for populations living in rural areas, this research aims to evaluate how far such interventions reached  for the improvement of health care in those communities. Through an interpretive case-based research strategy, our field studies uncover enthusiasm from the rural people towards availing health help line services and the intervention's contribution to improved health-seeking behavior.

Claim Mobile is a platform designed to support a project that subsidizes healthcare by reimbursing health service providers in Uganda for treatment of patients with sexually transmitted infections. As with many development projects, the Uganda Output-Based Aid (OBA) project involves a number of stakeholders: the service providers, the project implementers,the financiers, and the Ugandan government. Design of an appropriate solution requires meeting the various and conflicting requirements of all of these stakeholders. In this paper we detail the rapid design and testing of a pilot implementation of a mobile and web-based system for processing claims forms, based on two prior field visits to Uganda. Based on a comparative device study, semi-structured interviews, health clinic surveys, and a brief deployment, we affirm the selection of the mobile phone as a platform from the health clinic perspective, and further suggest that effective design for development requires more than addressing requirements of the the “users” of the mobile phones but also all the other stakeholders involved, who may have conflicting requirements.

The use of mobile and wireless technologies to support the achievement of health objectives (mHealth) has the potential to transform the face of health service delivery across the globe. A powerful combination of factors is driving this change. These include rapid advances in mobile technologies and applications, a rise in new opportunities for the integration of mobile health into existing eHealth services, and the continued growth in coverage of mobile cellular networks.

According to the International Telecommunication Union (ITU), there are now over 5 billion wireless subscribers; over 70% of them reside in low- and middleincome countries. The GSM Association reports commercial wireless signals cover over 85% of the world’s population, extending far beyond the reach of the electrical grid.

For the first time the World Health Organization’s (WHO) Global Observatory for eHealth (GOe) has sought to determine the status of mHealth in Member States; its 2009 global survey contained a section specifically devoted to mHealth. Completed by 114 Member States, the survey documented for analysis four aspects of mHealth: adoption of initiatives, types of initiatives, status of evaluation, and barriers to implementation. Fourteen categories of mHealth services were surveyed: health call centres, emergency toll-free telephone services, managing emergencies and disasters, mobile telemedicine, appointment reminders, community mobilization and health promotion, treatment compliance, mobile patient records, information access, patient monitoring, health surveys and data collection, surveillance, health awareness raising, and decision support systems.

Grameen Foundation’s experience of designing and implementing a mobile health program in Ghana can provide insights for the broader field and specific projects that are in early phases of planning and implementation. A fundamental tenet of Grameen Foundation’s work is to share information broadly, from program designs to management plans to source code to lessons learned - both successes andfailures. To that end, this document is intended to provide:

1) A comprehensive overview of the Mobile Technology for Community Health (MOTECH) project in Ghana and how it works.

2) An insight into strategic decisions and design approaches made by the project team throughout the course of the implementation.

3) Information on lessons learned during the project and implications of decisions on future scale.

Uganda suffers from a severe shortage of professional healthcare workers. Thus, programs aimed at prevention of disease are an important complement to the limited healthcare delivery system.

We analyze two deployments of an SMS-based HIV/AIDS education system that uses a quiz format to assess people’s knowledge of the disease, including its causes and methods of prevention. The deployments were to two groups in Uganda, one a sample of mobile phone users who live in a town in northwest Uganda; the other, workers at three factories in central and southeastern Uganda. The two samples had accuracy rates above chance levels and workers at the three factories had higher rates of participation (more individuals and more questions) than the sample selected from the cell tower service area. An analysis of incorrect answers suggested that while participants had some difficulty in matching the formatting required by the quiz, literacy did not appear to be a significant problem.

We discuss the results in terms of implications for using SMS as a user interface mechanism and explore the possibility of using social ties among participants as a way to promote the scalability and sustainability of this quiz-based education method.

The world is witnessing a new dawn with regard to the potential of information and communication technologies (ICTs) to contribute in the fight against poverty. For the first time, there are now realistic opportunities for inhabitants of remote locations in low-income countries to get connected via ICTs. Farmers, fishermen as well as entrepreneurs in urban areas are rapidly adopting mobile phones as a key tool to advance their commercial activities, and some poor people are finding new livelihoods on the back of this trend. Against this background, the Information Economy Report 2010 focuses on the nexus of ICTs, enterprises and poverty alleviation. Whereas the knowledge base needs to grow considerably, the evidence presented in this Report suggests that more attention should be given by policymakers and other stakeholders to this new set of opportunities.

The Report is organized into five chapters. Chapter I introduces a conceptual framework for the analysis that follows. Chapter II reviews recent connectivity and affordability trends to gauge the degree of access and uptake of different ICTs among the poor. Chapter III turns to the role of the poor in the production of ICT goods and services (the ICT sector). In chapter IV, the focus shifts to the use of ICT by enterprises, with emphasis on those that matter most for poor people, namely small and micro-enterprises in urban and rural areas. Finally, chapter V presents the main policy implications from the analysis.