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mHealth and humanitarian mapping: a brand new learning format

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New topics and a new methodology is allowing people to study everywhere and at their learning pace. Compared to the “traditional” formula used, with live streaming lessons and pre scheduled sessions, followed by exercises to be carried out autonomously between one session and the other, we have now launched a new blended formula that combines the advantages of e-learning without losing the added value of the direct relationship with the lecturer. The two new training courses proposed are dedicated to the use of GIS for Humanitarian Mapping and the use of mobile technologies in the health sector, mHealth for International Cooperation.

by Anna Filippucci

For more than 10 years, at Ong 2.0 we have developed an online training methodology based on the direct exchange between lecturers and participants. Over the years, this approach has been applied to over 20 courses and has allowed over 1100 participants to successfully be trained on various topics related to International Development Cooperation and Digital Communication for Non-profit organizations.

Alongside this methodology, this year we have decided to develop a new training path that integrates the advantages of e-learning with the essential direct relationship with teachers. It’s a whole new format, able to better respond to the needs of an audience that is gradually becoming wider and more international. The new course is based on asynchronous learning that allows more flexible management of time and provides a test system to evaluate progress.

A new learning formula that better fits the needs of professionals

Greater flexibility in terms of time is essential especially for aid workers, who need to combined different time zones and work duties and that, in the past, were struggling in respecting fixed scheduling and learning pace.

Topics themselves have been selected for professionals who need to acquire practical and advanced skills on specific tools. The online courses offer the possibility of experimenting with some “open” tools ready to be used in the field.

Moreover, two live workshops ensure direct interaction between lecturers and course participants for clarifying questions, share experiences and work on practical examples and challenges experienced by the participants.

What the lecturers say about this new approach to online learning

Giuliano Ramat, one of the lecturers of the GIS Open Tools for Humanitarian Mapping, explains: “the course aims to provide participants with information about the most important open source tools concerning Humanitarian Mapping mainly focusing on the Openstreetmap products, working groups and experiences.” 

Paola Fava, head of “mHealth for International Cooperation“, describes her course as “the opportunity to get a general overview of the use of mhealth in developing contexts. Its applications in the health sector are the most varied: from health surveys, to remote monitoring, to educational applications and to disease detection systems, to name just a few. The course therefore provides examples and case studies in this regard to stimulate the use of these technologies to improve and integrate new health projects “.

Regarding the new course format, Ramat states that ” the adopted e-learning formula makes participants free to attend lessons at any time they want and the division of the classic 90 minutes lesson into smaller “chapters” of 30 minutes each increases the capacity of concentration on “smaller” but well-defined topics.”

Paola Fava confirms: “flexibility and the possibility to manage our own time are key requirements nowadays, that’s why I believe this type of ‘formula’ matches people’s needs and time availability compared to more traditional webinars. However, both confirm the importance and value of the moments of interaction between lecturers and participants: “connection with the lecturer or other students is however granted by the moodle forum as well as some live sessions”.

Why English? According to Ramat, “English being the language mainly used in international cooperation, professionals who intend to work in the sector must necessarily get used to the idea of interacting with colleagues in a foreign language. In this regard, the opportunity to immediately acquire sector-specific English-speaking terminology is certainly an advantage for future workers“.

In this regard, Paola Fava concludes, “the idea is to reach a broader audience and I believe that the English language fits more into this purpose. We also had requests from previous people attending similar courses and found the Italian language a possible limit. Furthermore, the topic is related to a sector that has seen a growing interest particularly outside the Italian context and with field experiences in foreign countries where the English language is widely spread”.

Find out more about the course mHealth for International Cooperation
Find out more about the course GIS Open Tools for humanitarian mapping

Cash for Health Mobile Money

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Two examples of how mobile technology can support cash for health programmes and how financial payments have led to the emergence of “results-based financing” (RBF) mechanisms as an alternative financing model for healthcare.

By Paola Fava

 

‘Although the quality of health services is an essential condition for the success of any health action, underutilisation of health services is more often influenced by demand-side barriers rather than supply-side limitations’.

This statement is extracted from the ‘Cash-based Interventions for Health programmes in Refugee Settings’ review by UNHCR. However the document concerns specifically Refugees, I believe that it can be applied to the overall population, particularly in vulnerable contexts.

Interventions in the healthcare sector have been historically focusing on providing solutions to the supply-side of healthcare (healthcare providers) rather than the demand-side (access to health services by patients), except to provide access to health-related products (such as insecticide-treated bed nets) or to support nutrition.

However, in the last few years, we have seen a gradual shift towards addressing some of the challenges that vulnerable parts of the population face when in need of healthcare services. One of these challenges is the cost of basic health services, such as antenatal care or delivery care. Although there is still little documented evidence of the use of cash-based interventions for health services in the humanitarian context, some interesting examples are involving the use of mobile technology.

In this post, I am describing two examples of mobile applications of cash for health.

M-TIBA, a mobile wallet for medical treatment

‘In Kenya, 85% of women wants to give birth in a formal clinic, but only 44% do so. The number one reason cited by women is the difficulty of accumulating the US$ 40 needed to pay. In other words, poor access to financial services is a big part of why there is a healthcare access problem.’

M-TIBA is a mobile-based health wallet, that allows anyone to send, save and spend money specifically for medical treatment. Individuals can save money for themselves, for a family member or friends. Money stored on M-TIBA can only be used to pay for treatment and medication in selected partner clinics and hospitals.

Furthermore, in order to guarantee and monitor the quality of the provided healthcare services, partner clinics need to be recognised by the SafeCare standards.

If you would like to know more about this technology and its impact on the society, watch this video about M-TIBA being a supportive tool for pregnant women in Kenya.

Mobile money as incentive for health operators

In Tanzania, traditional birth attendants (TBAs) are typically paid to assist deliveries. It’s, therefore, a financial disincentive for them to refer their patients to health facilities, since this would represent a loss of income. However, health risks increase when deliveries are not performed in appropriate facilities.

In 2011, D-tree International, has launched a program in Zanzibar that provides TBAs with a mobile-enabled clinical guide to help them treat women and identify cases who should be referred to health facilities. Beside the medical aid tool, the system also includes an SMS-mobile money payment system that it’s used as an incentive for TBAs to assist and refer pregnant women to health facilities for clinical check-up and safe deliveries. Through mobile money, ‘TBAs are able to make prompt payment for transport for the woman to deliver in a health facility or in case of any complications for both mother and baby that require medical attention.’

TBAs’ mobile money accounts are used to transfer money to the drivers’ accounts at preset rates to carry the women to the appropriate facility for referral. After the TBA’s last follow-up visit, D-tree pays each TBA US$6 per facility delivery through mobile money as well, which is higher than the amount the TBA would make from an assisted delivery.‘

 

 

Artificial Intelligence and the Future of Mobile Health

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Ever heard about the use of Artificial Intelligence in mobile health in developing countries?

Well, if that sounds new to you; don’t worry, you are not alone. Last June, the United Nations Agency ITU (International Telecommunication Union) held a conference called ‘AI for GOOD Global Summit’, the first one in its kind,  to start discussing the use of Artificial Intelligence applied to developing context and to support the SDGs.

by Paola Fava

 

I remember over 10 years ago, while studying engineering, AI and robotics were quite new and fascinating subjects, but it was still a niche sector.The idea behind that is to build machines capable of thinking like humans, recognize information, picking up data from different sources, use that data to feed algorithms that can learn and improve their tasks. It sounds sci-fi, doesn’t it?

Well, since then, the AI potentials have been widely explored and applied in many sectors. Most likely, we have heard that Artificial Intelligence, machine learning, neural networks stand at the ground of driverless cars, of very smart computers that can beat chess champions or other applications of AI which are enabled by sensors connected to smartphone SIM cards.

However there’s much more to it. And more potentials may be out there ready to be explored also for developing countries, where the widespread of mobile phones and AI can go hand in hand.  I am quoting here Joel Selanikio ( Magpi CEO), who wrote in one of his blog: “we are beginning to realize that all the benefits (of mobile phones to global health) up to now have only been prelude to something with even greater impact on international health: the rise of artificial intelligence, delivered to even the poorest people in the world via the mobile phone.“

 

Mobile_Healthcare_techeconomy_importanza del mobile per la salute

 

Again, quoting Selanikio, ‘some examples of AI-mobile phone applied to health care  include:

  • ResApp Health, who have used AI to develop an application that listens to the sound of coughing and breathing and can accurately then diagnose pneumonia or asthma.
  • IBM’s Watson, which can diagnose cancer, and select appropriate treatment, more accurately than expert cancer specialists.
  • AiCure, a mobile app that uses AI to verify medication compliance (it can watch you ingest your meds) – and which could be used to scale directly-observed therapy (DOT) for TB (currently dependent on community-health workers) at low cost to all the places that current cannot afford it.
  • NIH facial image recognition algorithms that can diagnose genetic disease using a smartphone camera.’

 

Does that still sound sci-fi? Well, it’s real and it’s the future.

However, as there are always two sides to every story, the same applies to AI in healthcare.
Dr Margaret Chan, Director-General of the World Health Organization, in her opening remarks at the Artificial intelligence for good global summit, invites researchers and stakeholders to be cautious as medical decisions are complex and depends on context and values.

“Although machines can aid the work of doctors, organize, rationalize, and streamline the processes leading to a diagnosis or other medical decision, artificial intelligence cannot replace doctors and nurses in their interactions with patients.
… we must consider the context and what it means for the lives of people. What good does it do to get an early diagnosis of skin or breast cancer if a country offers no opportunity for treatment, has no specialists or specialized facilities and equipment, or if the price of medicines is unaffordable for both patients and the health system?
What happens if a diagnosis by smartphone app misses a symptom that signals a severe underlying disease? Can you sue a machine for medical malpractice? How do you regulate a machine programmed to think like a human?”

All of these questions are very important and we should not underestimate them.

 

Photo credits: the next web 

Birth registration is a child’s right

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A name and nationality is every child’s right, enshrined in the Convention on the Rights of the Child and other international treaties. Yet the births of nearly one-fourth of children under the age of five worldwide have never been recorded. This lack of formal recognition by the State usually means that a child is unable to obtain a birth certificate. As a result, he or she may be denied healthcare or education. Later in life, the lack of official identification documents can mean that a child may enter into marriage or the labour market, or be conscripted into the armed forces, before the legal age. Registering children at birth is the first step in securing their recognition before the law, safeguarding their rights, and ensuring that any violation of these rights does not go unnoticed.

Most countries have mechanisms in place for registering births. However, coverage, the type of information obtained and the use of resulting data can differ, based on a country’s infrastructure, administrative capacity, availability of funds, access to the population and technology for data management. Rates of registration vary substantially among countries, due to these and other factors.

Large differences can be found in the coverage of birth registration among regions. Central and Eastern Europe and the Commonwealth of Independent States (CEE/CIS) has the highest level of birth registration, with 98 percent of children under 5 registered. This is followed by Latin America and the Caribbean, at 92 percent, and the Middle East and North Africa, at 87 per cent.

The lowest levels of birth registration are found in sub-Saharan Africa (41 per cent). In Eastern and Southern Africa, only 36 percent of children are registered by their fifth birthday, while the rate in West and Central Africa is slightly higher, at 45 percent.

 

Percentage of children under age five whose births are registered by region.

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Source: UNICEF

 

Many UNICEF country offices are exploring the use of mobile communications technologies, including cell phones, to increase birth registration coverage. As a result, access to reliable data in real time is being used for planning and decision-making.

Mobile and digital technology can be used to obtain timely, accurate and permanent records.

In Uganda, UNICEF and a private sector partner, Uganda Telecom, are piloting a mobile and web-based technology to digitise birth records, making the birth registration process faster, more accessible and more reliable.

Cambodia case study

According to the Cambodia Demographic and Health Survey (CDHS) 2010, just over 62 percent of children under five are registered in Cambodia, which is lower than the 2005 figure of 65 per cent. CDHS 2010 also shows a huge gap in birth registration between urban and rural, and between the rich and the poor. 60 percent of children live in rural area registered their birth comparing to 74 percent of children living in urban. There is gap between the rich and the poor as well with only 48 percent of the poorest children registered as opposed to 78 percent of the richest as shown in the graph.

Since 2011 MOI, with UNICEF support, has been implementing a pilot initiative in 32 communes of three districts in Kampong Speu, Prey Veng, and Svay Rieng Provinces to model the most effective ways to address the issues that cause low levels of birth registration. The pilot outcomes will also guide key stakeholders for policy and programme adaptation.

There are many reason for this situation:

  • Lower value of and demand for birth certificates
  • The form/design of the birth certificate is not durable especially for rural families, who are at higher risk of damage and loss.
  • Communes and districts often experience a shortage of birth certificate supplies causing inconsistency and delays in providing birth registration services.
  • Parents find the process of birth registration of newborn children – especially late registration – complicated and rigid.
  • The paper-based, manual monitoring and reporting system leads to poor data management, low information quality and irregular or late information flow.

One of the recommended action is to implement a monthly routine outreach and real-time reporting of birth registration through short-messaging services (SMS).

To help solve this issue, UNICEF Cambodia together with General Department of Identification (GDI) set up a pilot IVR platform using a combination of RapidPro and the cloud communication channels Twilio and Nexmo. This solution would, for the first time, help ensure communes would never be out of stock and babies could be registered as soon as possible – a vital protection method for children.

Each month commune clerks report the number of forms and/or books in stock either by responding to the automated monthly calls initiated by RapidPro or by calling the system. The data is then analysed by RapidPro. If the numbers of forms or books in stock are below a certain threshold, RapidPro will automatically notify the district level by SMS and the province level and GDI by email. The district officers in charge of re-supplying forms and books receive SMS notifications on communes that need restocking, helping to ensure communes will be equipped to register all children.

RapidPro is being used all over the world in a variety of ways to assist children and families, supported by UNICEF’s Global Innovation Centre (GIC). The GIC acts as a centre of excellence that is powered by a growing global network of UNICEF offices, specialists and allies dedicated to using technology that can have a large-scale impact on the lives of children.

 

Photo Credit: Margherita Dametti for COOPI

Source: https://blogs.unicef.org/east-asia-pacific/harnessing-mobile-technology-improve-birth-registration-systems-cambodia/

 

Maps4health

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Maps4health? What is the connection between healthcare and maps? The 1854 London Cholera Outbreak map developed by Dr. John Snow is considered one of the very first example of Geographic Information System (GIS). Dr.Snow developed a sort of proto-GIS supporting his theory that cholera was a water-borne disease. His analysis showed a connection between number of cholera deaths and wells location.

By Paola Fava

This is just a very first example of the linkage between health and maps. Maps can be used for complex geographic analysis of health indicators but also simply to identify the exact location of health centers or healthcare services.

Particularly in emergency situations, such as the 2014 Ebola crisis in West Africa, maps were used to locate health facilities, laboratories, schools, wells and any other significant infrastructure that could provide information to support aid workers facing the emergency. Combining this information with other indicators such as population data, number of disease cases, etc… maps provided a better overview of the disease widespread and its effects. Hpfblog2ere is an example of maps developed by WHO showing, on the left, the location of laboratories in the areas affected by Ebola Virus in 2015 and, on the right, the number of Ebola cases in October 2014.

Identifying the exact location of health facilities is not always an easy task, especially if using a top-down approach, asking government bodies, health authorities or organizations.

On this regard, healthsites.io is an interesting tool, that uses an alternative, bottom-up approach to identify healthcenters around the world, providing information such as their geographic position, services provided, number of full time/part time beds, staff availability, etc…The application is an opendata initiative, therefore freely available and anybody can contribute by using their Facebook or Twitter account.
It’s a project co-founded by Mark Herringer, Tim Sutton and Dražen Odobašić, and supported by many partners such as ICRC, MSF, HIF (International Hospital Federation), the Health Care in Danger project and HOT(Humanitarian OpenStreetMap Team).

pfblog3

Healthsite.io can be particularly useful in emergency situation, (i.e.: in case of disease outbreaks or natural disasters) in order to have baseline data or assess damages or even, more importantly, to help people seeking for medical care. Of course, the main challenge is to verify the information and keep it updated but the network of organizations behind it, such as the Humanitarian OpenstreetMap Team (HOT), MSF and ICRC, is already a great start!

Photo credits:
Main photo: Ted Eytan
Photo1,2: WHO EbolaMaps
Photo3: Healthsites.io

Digital Health Information Fragmentation

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Small health centres in remote villages in some regions of Africa can be quite crowded places…
Those crowds are not only made by patients but also by NGOs’ and organizations’ staff who are running their programs by bringing different types of medicines or collaborating with health staff to collect healthcare information.
Each organization brings its own project, maybe a pilot one, with a good amount of requests or activities to be implemented. So, for example, beside already established standard government forms or registers, community Health Workers (CHWs) are asked to fill out additional forms/registers.

Although the final objective should be to facilitate their work and improve the provision of health care to the most needed, unfortunately this often creates an extra burden to the already understaffed facilities, it generates confusion, overload and waste of precious time on bureaucracy, time that should be rather spent on patients’ care. Furthermore, health workers may receive incentives for the extra workload, thus changing work priorities resulting in poor/ late reporting of standard and well established data to the Ministry of Health.

Many of those pilot projects also involve the use of digital information, using digital data instead of paper forms.

A significant example of the fragmentation of digital health programs is illustrated on the measles map of Uganda developed by Sean Blaschke at UNICEF, as mentioned by Dikki Sepfblog5ttle in his post on Pathblog. The map itself explains why in 2012 the ministry of Health in Uganda called a halt to all eHealth and mHealth Initiatives in the country until they got approval from the Director General of Health Services. The objective was to limit the fragmentation of programs and make sure that the data collected up to that point would feed into the national digital Health Information System, rather than creating additional parallel systems.

The widespread of digital information is already a step forward towards the integration of information as ICT can facilitate the information and data exchange especially if data is collected in appropriate and compatible format.

However, we are still quite far away from the final objective…. And, as David McCann wrote in one of his post on ICTworks about the situation in Uganda, reality sounds more like this:
” You’ve managed to track drug stock-outs in a sub-county in Moroto using solar chargers and 50 Samsung Galaxies. That’s great, can we share data with a similar project I did using BlackBerries in Gulu? Probably not. You’ve rolled your own drug-stock-tracking application. And yet when members of Big Aid met with the Ministry of Health, to account for the overlapping features of their mHealth applications and whether API integration is possible, one actually responded along the lines of “well, it’s backed by a relational database, so in theory, yes.” While true, this misses the intent of the question by a wide margin’.

Maybe the halt promoted by the Ministry of Health in Uganda is a way towards increasing interoperability and coordination of projects. For sure, it indicates that government has started to look into taking ownership of these projects and technology to serve the population’s needs.

In other countries specific mobile-health groups, such as the mhealth working group in Malawi, are meeting regularly, with the involvement of the Ministry of Health, to face the issue of integration and overlapping of mobile health projects.

Both the use of compatible technologies and the involvement of stakeholders at various levels are two key elements to start overcoming the problem of mhealth projects fragmentations.

By Paola Fava

Photo source: Margherita Dametti for COOPI

RapidSMS: an example of mhealth application

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Mhealth tools can be deployed with many functionalities, such as: data collection, point of care, logistics, remote monitoring, treatment adherence, education awareness, training, and disease tracking. Read more

Welcome to the mHealth Blog

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Hello everybody! My name is Paola Fava, I am a business developer and co­founder of Gnucoop, an IT cooperative that provides software solutions to support not for profit organisations (i.e.: NGOs, UN Agencies, etc…) in managing their information systems, from data collection to data visualization and analysis. I would like to thank ONG2.0 for giving Gnucoop the possibility to use this space to share with you some interesting facts, information or talks about mHealth, mHealth tools, presentation of case studies and user’s

So, let’s start blogging!

We start with some basic information… what is mHealth? First of all, we need to understand what an health system is. An Health system is a combination of structures, processes and resources required to deliver healthcare to the population. Therefore, this system needs financing mechanisms, well trained and paid workforce, reliable information and well ­maintained facilities to guarantee a good service to patients.

Where does the mHealth come in then?

Well, in some contexts those requirements are not totally fulfilled. Particularly when reliable information is missing, it is very difficult to monitor the spread of diseases, understand if patients’ conditions are properly diagnosed or if proper treatments are given, just to mention a few… here is where mHealth can play a very important role.

According to WHO, Mobile Health (m­Health) is the “Provision of health services and information via mobile and wireless technologies. mHealth includes mobile phones, Personal Digital Assistants (PDAs), tablets, mobile applications and wireless medical devices“.

mHealth has the potential to address and overcome challenges such as:

  • Disparities in access to health services, helping remote communities to also connect and avail of health services;
  • Inadequacies of the health infrastructure, supporting in monitoring the quality of health posts and health centers;
  • Shortage of human resources for health, by empowering health promoters and spreading educational messages.

Let’s start with a first example of mhealth tool: the MAMA (Mobile Alliance for Maternal Action) project.

MAMA is an SMS system developed through a public private partnership between USAID, Johnson & Johnson, the United Nations Foundation and BabyCenter. It supports programs delivering maternal health information to pregnant women by SMS. The messages are built around key health behaviors and interventions which evidence shows can improve health outcomes. The messages blend healthcare with child development information, so mothers are motivated to get the right care at the right time for themselves and their children. These include antenatal care, nutrition, vaccination, oral rehydration, and use of insecticide­ treated bed nets.

Since 2011, the system has reached 2 millions people among women families and caregivers living in remote communities in Bangladesh, South Africa, India and Nigeria. MAMA messages empower women to make the best decisions for themselves and their families.

Talk soon about another mhealth tool or case study.

 

Originally written by Paola Fava
Photo Credits: Educational text messages to new mothers save lives

 

Mobile money to improve maternal health, an African story

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posted by guest writer Patricia Mtungila* from Lilongwe, Malawi

Healthcare in Africa is reaching a whole new dimension with the introduction of mobile money to health systems. Mobile money itself takes many local names by the countries but be it Mpesa in Kenya or Mpamba in Malawi, the power of these mobile money services is now being harnessed to take reproductive health services, health insurance and and universal health coverage to those who needed most, the poor masses of rural Africa.

Sharing her story at the Africa Regional Meeting on Digital Health**, Erica Layer of D-Tree tells the success of the lives of women in Zanzibar who have had safe digital deliveries in medical facilities as opposed to the age-old norm of home delivery which has been a part of life in Zanzibar until recently.

Through a mobile-money based initiative, D-Tree transfers mobile money into the mobile phones held by community health volunteers who monitor pregnant women. In this way, through the mobile phones they are able to closely link the health centres with the expectant mothers by keeping the health officials informed about health status of pregnant women living in their areas in between medical centre visits. At the time of delivery, the community volunteers inform the health facilities and communicate with a network of taxi drivers in charge of providing the transport to the hospitals.

Despite its huge success, D-Tree’s m-health initiatives in Zanzibar are not without challenges: Erica Layer highlights difficulties in forecasting transport needs of the mothers, the need for a culture of digital reporting and accountability among the community volunteers. She also calls for improvement in connectivity and in an automated medical record system. Nevertheless, the programme has been hugely successful and will be scaled out to Tanzania.

photo credits: africahealthitnews.com

* Patricia Mtungila works as communication officer at UbuntuNet Alliance, the regional Research and Education Networking organization for Eastern and Southern Africa (NRENs). She got the scholarship to take part in the ICT4D course run by Ong 2.0 since February. Follow her on Twitter and on her blog.
** It’s a three-day regional conference on mobile and digital health supported by USAID and the UN Foundation and kicked off in Lilongwe, Malawi (13-15 May 2015). The meeting aimed to tackle how the use of digital health can overcome barriers to ending preventable child and maternal deaths and help achieve universal health coverage.