mHealth Working Group

Wednesday, March 23rd, 9:30am-11:00am

AED, 1875 Connecticut Avenue, Washington, DC

Meeting Discussion Items

  1. Upcoming Meetings
  2. Review of mLearning Literature & Discussion
  3. Mobile Health Information System (MHIS)by Holly Ladd, AED-SATELLIFE
  4. Mobiles for Quality Improvement (m4QI)by James Bon Tempo, Jhpiego, and Pamela Riley, Abt Associates
  5. Mobile Behavior Change Communication (mBCC) Field Guide by Shalu Umapathy, Abt Associates
  6. Potential Group Activities

The presentations which accompany these notes, as well as notes and presentations from previous mHealth Working Group meetings, are available on the mHealth Toolkit at

1.Upcoming Meetings

We greatly appreciate AED hosting the March 2011 meeting of the mHealth Working Group. The May meeting of the mHealth Working Group will be hosted by the World Bank, and the July meeting will be hosted by JSI. We are seeking hosts for the April andJune meetings. If your organization would like to host the group or an internal brown bag, please contact Kelly Keisling () and Laura Raney ().

2.Review of mLearning Literature & Discussion
Kelly Keisling provided an overview of the literature on mLearning for general audiences and for health care providers. Recapping the Working Group’s May 2010 discussion on mLearning, the advantages and limitations of mLearning were reviewed (see slides). The previous discussion also raised the precedence set by eLearning, the importance of not merely “cutting and pasting” trainings from another format into mobile devices, the difference between self-directed learning vs. preset formats, and synchronous vs. asynchronous uses. Kelly noted how the abstract discussion last May had progressed to this month’s discussion of pilots by member organizations.

3.Mobile Health Information System (MHIS)

Holly Ladd of AED-SATELLIFE Center for Health Information and Technology presented on the Mobile Health Information System (MHIS) project. The goal of this collaborative initiative in Port Elizabeth, South Africa was to build the capacity of professional health care workers in resource-poor urban health settings to improve patient care by providing them with locally relevant clinical information at the point of care.

Experience from AED-SATELLIFE’suse of mobile technology in 20 countries indicates health care providers’ ability to provide better patient care is enhanced when they are can access relevant health information on mobile computing devices. Previous work on the Uganda Health Information Network (2003) tested PDAs for health workers for collection and transmission of public health data (HMIS) and disease surveillance along with a static library of treatment guidelines published by the Ministry of Health. The South African MHIS project used mobile devices for the delivery of health and medical information. Mobile phones haveparticular challenges with format limitations.

A needs assessment revealed that nurses required a reference material which was easily accessible, and the nurses’ top issues included extreme multiple drug resistant tuberculosis (TB), HIV/AIDS, multiple drug resistant TB, ARV, PMTCT, non-communicable diseases, STIs, malaria and public health legislation. The clinical content identified from the needs assessment was packaged for mobile phones. The mobile library of local and international content included a 360-page treatment guideline document, in-hospital protocols, and a common drug list. Fiftyclinical nurses were trained to use smart phones loaded with the digitized evidence-based health information. AED-SATELLIFE’s GUIDEcontent management system was used to convert these large documents into a format that was easily accessible from smartphones. Due to the file size, the documents were preloaded on smart phones that were provided to nurses for free.Nurses were also given limited credits for talk, text and internet access. Refresher training and technical support for the nurses were emphasized.

An external evaluation of the project showed that nurses self-reported improved practice,though it isdifficult to determine the impact on health outcomes due to short-term nature of program. Nurses found it easy to find and read content on the smart phone,although the device was complex and uploading new content was time consuming. Nurses also reported that they would buy their own phone if study ended and theirs was taken away.

Lessons learned: It is difficult to attract funding for an electronic library, so integrating the library with data collection can attract funding and spread costs. Partnering with the mobile industry posed difficulties for the pilot. The corporate partner required use of a particular type of smart phone. The cost of the high-end phone distorted the cost structure of the pilot, and the potential for cost-effectiveness at scale. The local mobile operator provided troubleshooting and training, but had to be reminded repeatedly to deliver their discounted service. It appeared that corporate partners invested more in advertising their participation than they invested in the project, itself.

In group discussion, Holly mentioned that the South African pilot occurred in an urban area that was not a particularly low-resource setting. Phones were provided to a concentrated group of nurses to better influence their practice. Some of the pilot limitations were the minimal amount of phones and participants in the study. 50 nurses were given phones,but doctors and pharmacists complained that they wanted the same access. MHIS seemed to empower nurses to question doctors’ diagnoses or to begin treatment plans while waiting for doctors’ diagnoses, perhaps influencing task shifting or work flow. Study participantssigned a statement taking responsibility if phones were lost or stolen, although this did not occur during the study. Evaluation of interventions is highly recommended at this stage of development in mHealth. The novelty of smart phones was less influential in MHIS than it was in past pilots, as the devices have become more commonplace in project sites. Instead, access to the MHIS library attracted more attention from care providers than the device, itself. Nurseswanted more information as well as locally-defined content from the hospital. Information should be tailored to the population and the location. Teachers might need international level information, while health care worker level might need local information. Pubmed articles were not provided on the phones because they require buying the articles and the information can be out-dated due to the publishing process. eGranary was used in previous projects, but content is restricted by publishers. Any scale up of the pilot would require partnership with the Ministry of Health, which has shown interest but not assigned responsibility. The hospitalIT department would also need to assign staff to manage the server and content conversion. Growth of the program would require assignment of management to either the IT or continuing education department of the hospital, which could depend on the range of services supported by HMIS.

4.Mobiles for Quality Improvement (m4QI): SMS for Learning, Assessment and Performance Support

James Bon Tempo of Jhpiego, and Pamela Riley of Abt Associates presented on the pilot, Mobiles for Quality Improvement (m4QI). Working with Marie Stopes, Appfrica Labs and other partners in Uganda, the project’s focus is quality improvement and quality assurance in family planning.Through the SHOPS project, an application of FrontlineSMS called FrontlineSMS:Learn was developed for the pilot. FrontlineSMS:Learn will be released to the public by this summer. It enhances the assessment function of FrontlineSMS to send quiz questions with automatic responses for remediation.

m4QI, which is still in the development phase, will pilot the use of SMS to improve providers’ quality of care. All interviewed clinic staff in pilot sites have cell phones and expressed interest in participating. The pilot will focus onresponsibilities shared by all staff, such as pain management and infection control.These behaviors are addressed by identifying gaps in knowledge, barriers to adherence to standards, and learning principles such as repeated messaging and testing. Local staff contributed to the content development.

m4QI is intended to reinforce content that was learned during training. Through SMS quiz questions, supervisors are able to develop targeted follow up for improved knowledge. The m4QI pilot will begin soon and will last eight weeks, providing initial results on quality improvement around July. Once the pilot has been completed and evaluated, m4QI can be used by any organization. It is particularly promising for addressing the need of non-networked providers in the private sector.

Interested organization are encouraged to consider how they can adopt similar designs and software. Frontline SMS Learn will be free and open source software. The use of free software on low-end phones is intended to provide low-cost and appropriate technology.

Pilot Comparisons

MHISand m4QI use different designs and devices to improve the knowledge of care providers. MHIS uses high-end phones and preloaded content to deliver large amounts of complex information. m4QI uses SMS to evaluate knowledge and to reinforce formal training, not to deliver new content toproviders. Presenters agreed thatmLearning should ideally provide both content and measurable learning. Presenters discussed opportunities for collaboration to link complementary mLearning systems for users that seek more information by phone.

5.MBCC Field Guide by Shalu Umapathy, Abt Associates

The mBCC Field Guide is being developed to providea practitioners’ guide to developing mHealth for behavior change communication. The mBCC technical group is preparing a draft version at asked the group to provide information (two paragraphs) on case studies from those organizations doing mBCC work in the field.Meeting participants suggested including C-Change, IRH Cycletel and FHI’s m4RH.The main areas of the Field Guide are situation analysis, audience segmentation, behavior change objective, positioning approach, messaging, channels and tools, management, and monitoring and evaluation.

The next meeting of the mBCC Working group will be hosted by Abt Associates in mid-April. Ideally Abt would like to include the case studies into the draft guide before then. Organizations that are interested in participating or providing cases studies should contact Shalu at and Kelly, .

6.Potential Group Activities

Building on the knowledge sharing between organizations, members’ suggestions for collaborative projects were discussed at the meeting.

  • Coordinated participation in upcoming conferences: participants discussed preparing jointly for the upcoming Mobile Health Summit in Cape Town on June 6-9( as well as the Conference on Family Planning: Research and Best Practices in Senegal on November 29- December 2 ( Group members planning to attend either conference are invited to respond and be connected to interested colleagues. Panel abstracts for the family planning conference in Senegal are due June 1, and members can coordinate a joint panel submission.
  • Report on challenges to mHealth adoption and scale up: a collaborative report could provide implementers’perspectives on requirements for progressing beyond short-term pilots. Discussion raised the point that lack of evidence has already been defined as a barrier, but organizational limitations and local context may require further attention.
  • Guide for organizational strategy on mHealth: how to internally coordinate mHealth projects in alignment with organizational goals.
  • Guide on funding criteria for mHealth projects: as organizations and funders consider the growing but ill-defined opportunities for mHealth, commonly agreed funding criteria could clarify expectations and support productive investment.
  • Catalogue of member programs in mHealth:a public inventory could exhibit the activities of member organizations and support collaboration. Discussion raised the point that several efforts are already underway to inventory mHealth activities.
  • Step-by-step guide to developing mHealth projects: summarizing the basic steps to implement mHealth could facilitate adoption of mHealth by program managers.

If you are interested in participating in any of the above activities, please specify which interests you to Kelly Keisling () and Laura Raney ().

About the mHealth Working Group

The mHealth Working Group is a collaborative forum for sharing and synthesizing knowledge on mHealth. Founded in August of 2009,the Working group seeks to frame mobile technology within a larger global health strategy. By applying public health standards and practices to mHealth, we promote approaches that are appropriate, evidence-based, interoperable and scalable in resource-poor settings. The Working Group holds regular meetings in Washington, DC to discuss promising approaches, challenges and lessons learned. The mHealth Working Group also supports the mHealth Toolkit, an electronic collection of information on the opportunities and the challenges of mHealth at

If you would like to join the mHealth Working Group listserv, please go to

mHealth Working Group

Meeting Participants 3/23/2011

Name / Organization / Email
Shalu Umapathy / Abt Associates /
Pam Riley / Abt Associates /
Tammy Loverdos / AED /
Bamikale Feyisetan / AED /
Holly Ladd / AED /
Ann Jimerson / AED ARTS /
Sandra Kalscheur / AED C-Change /
Itay Efraty / BroadReach Healthcare /
Monica Trigg / CARE /
Mohammad Syar / CCP /
Rebecca Shore / CCP K4Health /
Alicia Diaz / Chemonics /
Ann Hendrix-Jenkins / CORE Group /
Audrey Spolarich / Danya /
Akshai Prakash / Deloitte /
Nathan Clarke / Deloitte /
Mwombeki Fabian / Duke University /
Larissa Jennings / Elizabeth Glaser /
Laura Raney / FHI /
Sarah Searle / FHI /
Eric White / Integra Government Services /
Laurie Moy / Integra Government Services /
Jordana Huchital / Interactive Outcomes /
James BonTempo / Jhpiego /
Sarah Bergman / JSI /
Nick Ramsing / MEDA /
Sarah Struble / mHealth Alliance /
Kelly Keisling / mHealth Working Group /
Katie Powell / MSH /
Andrew Karlyn / Population Council /
Jasmine Hutchinson / PSI /
Mariah Preston / PSI /
Sarah Robbins-Penniman / PSI /
Patricia Flanagan / USAID/EGAT/I&E/ICT /
Peggy D'Adamo / USAID/GH/PRH/PEC /
Sanjay Patel / WebFirst /
Maggie Usher-Patel / WHO /
Taroub Faramand / Wi-her /

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