Health Informatics briefings

1. Informational Briefing
Futures Group eHealth and mHealth

2. Implementing eHealth and mHealth for Low
Resource Communities
Bobby Jefferson, Senior Health Informatics Advisor, Futures Group
Manage 36 Programmers India (10) , South Africa (10) , Kenya (10), Tanzania (2),
Nigeria (1), Guatemala (1) , Uganda (2)
• U.S. Government President AIDS Relief Program $15 Billion – 10 Countries HIV,
Prevention Mother to Child Transmission, TB, OVC
• Principal Investigator– National Health Informatics System (HMIS) Kenya
Datawarehouse , National Electronic Medical Records 6,000 hospitals
• Lead IT Project Manager- Community Level Orphans and Vulnerable Children
(OVC) electronic data system (World Vision, UNICEF, CRS, Africare) – Zambia,
Tanzania
• Health IT Advisor - 5 Central Asia Republics (CAR) Consortium for AIDS
Strategic Information in Central Asia (CASICA)
• Kazakhstan, Kyrgyz Republic, Tajikistan,
• Turkmenistan, Uzbekistan

3. Staff Profile
 502 Staff
 30+ countries
 Multi-disciplinary
 Majority doctoral and masters-level
3

4. CHSS Geographic Focus
Europe & Eurasia
Georgia*
Ukraine
Asia and the
Africa: Middle East:
Kenya Afghanistan
Latin America and Lesotho* China*
the Caribbean: Mozambique India
Guatemala Nigeria Pakistan*
Guyana Rwanda
Haiti Tanzania
Honduras Sierra Leone
South Africa
Swaziland
Uganda
Zambia
Zimbabwe*
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5. Informatics Solutions
• IT Database related to Poverty Reduction
– Social Cash Transfer
– Household base assistance, community
empowerment,
• Mobile Surveys
• Monitoring and Evaluation system
• PPP
• Capacity Building, Knowledge Transfer,
– Site Capacity Assessment (SCA) tool

6. 6

7. Low Resource Environment
We are working across 15 Countries, 1,033 Hospital Facilities + Satellites Clinics ,
Antenatal Care – 535 PMTCT sites
Rural, remote, hospitals “serving poorest of poor” and Ministry of Health (MOH)
facilities, Rural health facilities serving BPL, marginalized and most vulnerable
populations
• Intermittent power,
• Lack IT staff,
• Lack internet,
• Sparse mobile coverage
• Lack of referrals, or linkage between HIV, PMTCT, TB,
• Cost effectiveness and sustainability -- no funds for proprietary licenses, or
yearly maintenance fees

9. Results
# of Facilities
• No Internet
• Sparse Mobile Coverage
• Intermittent Power
• Mobiles, SMS
• Smartphones
• Internet
Rural, Remote
City Online Mobile Offline, Disconnected
Solutions Solutions Solutions

10. Low Resource Environment
Nurses, Clinicians, Adherence Counselors, need health data, M&E program
data in knowledge repository
• Lack of referrals, or linkage between HIV, PMTCT, TB, or to existing
technology systems
• Cost effectiveness and sustainability -- no funds for proprietary licenses,
or yearly maintenance fees

11. Approach
Use of freely available, reusable, tools, “coded in country”
Creative commons approach
Reusable software and technology across countries and
programs
Offline Solutions, Disconnected model
Local programmers, all IT staff in country (India, Kenya, South
Africa)
- Offer Programmer training SQL, Agile process, Virus
Remediation
Low costs, Inexpensive $200-$350 Netbooks , Solar netbooks
Solar mobile phones, SMS instead of Smartphones
-

12. Naveen
Jayanta Piyush Sharma Sanjay
. Das: Khanna Rana Ajay Sharma
Rajketu Santosh
,
Singh Ghandi
Archana Mahawar Deepika Sain, Kanchan Verma
Meetu Rahul
Futures IT Team in India

13. Collaborators and Users
Users Intra Health International
ICAP Columbia University 44 sites
World Vision Intra Health International 17 sites
Clinton Foundation Elizabeth Glaser EGPAF 16 sites
Columbia University Catholic Relief Services - 32
Family Health Inter FHI 45 sites
UNICEF Pathfinder International
Catholic Relief Services 13 sites
DFID Gertrude Children Hospital
DOD Walter Reed - 28
Mount Kenya University
MOH Kenya Sites
Mennonite Christian Charities
AIDSRElief 35 sites
Ministry of Health AIDSRelief
Ministry of Education John Snow International
Rakai Health Services Vaccine Research
PMTCT , ANC sites 535 sites
Elizabeth Glaser EGPAF

14. Health IT Solutions
Collectively referred to as IQSolutions
1. Electronic medical records
1. IQCare
2. Independent Technical Evaluations Performed
WHO, USAID, CDC Atlanta, CDC in-country, Ministry of
Health
2. Mobile Phone solution (IQSMS technology)
3. Visual Dashboards
4. Monitoring & Evaluation Electronic reporting
•

16. Clinicians able to review individual patient
histories
*Clinicians review patient histories, prescribed drugs, ordered tests and results, and progress on care and treatment
during the exam

17. demo
http://173.203.65.108/iqcare/frmLogin.aspx
 Username: user1
 Password: 1
 Facility/Satellite: 001-01-01-Demo Site

19. Mobile Phone Reporting by Remote Workers

20. IQSMS PMTCT Reports
PMTCT Currently consists of 4 types of monthly reports
1. PMTCT Antenatal Clinic (ANC) Monthly Summary Form
2. PMTCT Care Register Monthly Summary Form
3. PMTCT Maternity (L&D) Monthly Summary Form
4. PMTCT Mother - Child followup SummarForm

21. PMTCT Report
Data Quality Checks
Must Pass All Data Quality Rules,
District Office
Monthly and Quarterly
Reports

22. NUMBER OF CLIENT HAD HIV TEST AT ANC

23. M&E Electronic Reporting System
Solar Power Cell phones
Orphans Vulnerable Children
PDA device
(OVC), Most At Risk
Population (MARPS),
Maternal Child Health (MNH)
Ms Access Database
Excel
PMTCT MONTHLY REPORT
PMTCT Antenatal Clinic (ANC) Monthly
Excel Only Summary Form Web Internet
118 Desktop
ANC 01. New ANC clients this month 8
ANC 02. Previously known to be HIV
positive 17
ANC 03. Total number tasted 574
ANC 04. Number of new client had HIV test
at ANC 277
ANC 05. Tested HIV-Positive 37
ANC 06. Post-test counseled for positive
and negative 574
ANC 07. Number of partners tested for HIV 16
ANC 08. Tested HIV-Positive 4

24. UNICEF Social Cash Transfer
Application
Futures Group International

28. STEPS OVC
• STEPS OVC = Sustainability Through Economic
Strengthening, Prevention and Support for Orphans and
Vulnerable Children
• Program provides
– Support for HIV prevention and behavior change
initiatives
– Reducing HIV transmission
– Support for OVC, at-risk youth and adults, and other
vulnerable populations
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29. STEPS OVC Login
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30. STEPS OVC Beneficiary Search
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31. STEPS OVC Beneficiary - OVC
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32. STEPS OVC Reports
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33. ICT for Development – Best PC Security Practices

34. District Health Training - Mobile
Phone Survey using SMS

36. Held Training of 600 District Health Officers in Kenya
On New District Health Reporting Tool
Ministry of Health NASCOP
SMS 1:
Have you entered /Imported data into the new tool ? Yes or No
SMS 2:
Have you run reports using the new district tools ? Yes or No
SMS 3:
Have you discussed the new district tools and reports with other members of the
district health team ? Yes or No
SMS 4:
In what district do you work?
Your answers are confidential and a Ksh 20 refund will be given for each valid reply

37. Mobile Phone Survey Architecture
Survey questions and
acknowledgement via SMS
SMS Provider
service Survey responses/corrections via SMS
(Zain/Safaricom)
SMS archived in Get SMS data Assessment
frontlinesms application DB FrontlineSMS Application
content to DB data
Convert SMS
Request for correction
No
Acknowledge Assessment Yes
(Reimburse airtime) Database Save
Valid?
(Excel)

38. Graph 1: N Participated = 165; N completed = 101
Percentage participation/completion in the DHPT text message survey by province
8 provinces involved in the survey, a total of 388 interviewees sent
some reply; 101 interviewees completed the survey

39. Response duration and times
Table 5: Time in minutes to complete the survey
Province N= Minimu 25th Median 75th Maximum Mean
131 m Percentil Percentile
e
Central 12 11.00 22.00 27.00 59.00 5861.00 999.33
Coast 12 5.00 9.00 27.00 54.50 969.00 106.75
Eastern North 5 15.00 17.00 25.00 30.00 31.00 23.60
Eastern South 20 3.00 9.00 18.00 480.00 9703.00 1202.10
North Rift 17 15.00 34.00 50.00 262.00 17561.00 2512.06
Nyanza 22 9.00 19.00 27.00 152.00 17534.00 1722.05
South Rift 19 2.00 15.00 35.00 1623.00 27553.00 3162.63
Western 24 4.00 768.00 1372.50 19012.50 30063.00 9424.38
Graph 2: N: 131 interviewees who responded to at
least 2 questions
Median times (in minutes) participants used to
complete the SMS survey

40. Response duration and times
• Most of the respondents attended to the SMS after 5pm
• Sending multiple questions drastically reduces the response rate
• Re-sending an answered question does not guarantee a response
• Contact (physical, by mail or otherwise) significantly increases
the response rate
• The longer the duration between a response and the next question the
lower the chances of getting the next response

45. www.futuresgroup.com
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www.twitter.com/FuturesGroupGbl
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