Mhealth Working Group Meeting Notes

mHealth Working Group Meeting Notes

Wednesday February 23, 9:00 am – 11:00 am (Eastern Standard Time)

Held at PSI, 1120 19th Street, NW Suite 600 Washington, DC

Meeting Discussion Items

1. Announcements

2. ILSGateway by JSI

3. Ongea Zaidi na Salama by PSI

The presentations which accompany these notes, as well as notes and presentations from previous mHealth Working Group meetings, are available on the mHealth Toolkit, under the mHealth Working group tab, Working Group Materials, at: http://www.k4health.org/toolkits/mhealth

1. Announcements

We greatly appreciate PSI hosting the February 2011 meeting of the mHealth Working Group. Steven Chapman, PSI’s Chief Technical Officer, opened the meeting. The next meeting will be held on the morning of March 23rd, 2011 at the Academy for Educational Development in Washington, DC. If your organization would like to host a future meeting or internal brown bag, please contact Kelly Keisling (note new e-mail address: ) and Laura Raney (), mHealth Working Group co-chairs.

Kelly Keisling is leaving the Johns Hopkins Center for Communication Programs to become an independent consultant on mHealth. As the Egypt program on which he works is closed out, he wishes a bright future for Egyptian people. Kelly will transfer to Laura Raney the management of K4Health’s mHealth Toolkit, which has generated over 10,000 downloads of evidence-based and relevant information. Kelly will continue to co-chair the mHealth Working Group with Laura to jointly support the growing leadership and collaboration among over 150 participating organizations.

2. ILSGateway

Marasi Mwencha, Senior mHealth Advisor for John Snow, Inc. presented ILSGateway: mHealth Logistics Reporting System Designed to Strengthen the Integrated Logistics System (ILS) in Tanzania. The integrated logistics system (ILS) manages categories of products for maternal and infant health. Current challenges include stock outs, irregular ordering, decision makers’ lack of access to facility-level data and inability to organize stock status data. The ILSGateway is a mobile health reporting system designed to expand the accessibility and visibility of the established ILS. The ILSGateway provides real-time stock status information. It intends to improve the timeliness and accuracy of ordering, reporting, and delivery confirmation. It is designed to increase the regularity of ordering, and to monitor facility-level supervision.

Under the ILSGateway, facility staff are registered to receive SMS queries on a quarterly or monthly schedule. Staff receives SMS confirmation of submitted data and supplemental messages on stockout alerts and request for additional help. Staff sends SMS on their personal phones to a toll-free short code. The data is processed by a web database and displayed for registered users on www.ilsgateway.com. The website displays alerts, summary graphics, stock status, R&R submission status, supervisory tools and a facilities map. The data flow by SMS complements the paper-based method that is already in place.

In group discussion, Marasi said the pilot’s goal is to strengthen the processes already in place rather than to change the paper-based system. Dual methods of data submission may increase accuracy. SMS was selected because many participants already have familiarity and hardware capability for text messaging, and other data standards face local infrastructural challenges. Because sending large amounts of information by SMS could cause confusion in interpreting shorthand codes or require excessive use of messaging, JSI expects that 10 products is the maximum number that ILSGateway can track at a given time per facility. The ILSGateway will soon have new features that would allow it to track any type or grouping of commodity used in the ILS. The reporting burden on staff should not be increased unduly because texting is quick and the data has already been recorded as part of the R&R forms. Users can opt out, though this has not occurred. The option is available in case of staff turnover, at which time ILSGateway reporting would be transferred to a backup staff member since reporting by facility representatives is mandatory. ILSGateway does not provide monetary incentives for users because the project is expected to be more sustainable and scalable without incentives. ILSGateway instead relies on training and accountability to provide a supportive culture and to ensure system use. Marasi was surprised how quickly users adopted ILSGateway, but disappointed at the response levels for some data categories. Regarding questions of program maintenance and cost, JSI plans to transfer ILSGateway to Ministry of Health officials who have been involved in the development process. JSI’s local implementing partner is D-Tree International. The ILSGateway cost under $200,000 to develop, using the open-source community. Extending the system to 5,000 facilities would cost an estimated $100,000. Discounts on SMS rates may be sought from telecoms, possibly in return for a tax break from the government. SMS costs comprise a major portion of the current cost structure and variable costs in scale up. JSI began the ILSGateway pilot in December and should have preliminary data next month. JSI anticipates the pilot will last six months before possibly expanding nationally. Scale up would be largely dependent on provision of training. JSI is currently open to engaging with other programs and pilots, and this is most appropriate where programs share synergies and health objectives. For example, JSI’s ILSGateway could conceivably be connected with FHI’s M4RH pilot to show family planning clients where facilities have products in stock. Knowledge sharing on mHealth is already underway in Tanzania, where JSI, PSI and others have participated in local conferences. The Tanzanian Ministry has also assigned an officer to mHealth.

3. Ongea Zaidi na Salama

The second presentation of the day was given by Margot Mahannah, Associate Program Manager, East Africa for PSI on behalf of Daniel Crapper, PSI’s Country Representative in Tanzania. The presentation was on Ongea Zaidi na Salama: Using Mobile Phone Networks to Improve Condom Social Marketing in Tanzania. Ongea Zaidi na Salama means Talk More with Salama, and this mHealth system supports distribution of PSI’s Salama-branded condoms to retailers. Challenges to distribution include overreliance on PSI teams for distribution due to retailers’ preference for ordering higher-value staples like sugar and batteries. mHealth is used to motivate retailers to maintain available stock of condoms. PSI decided to incorporate mHealth based on high mobile phone ownership and SMS usage among the target audience of retailers.

The solution provides a loyalty reward program that gives retailers airtime in exchange for condom orders. Retailers receive a scratch card with each condom dispenser, then register their information and scratch card code by SMS. With this data, PSI can track the product availability by ward and evaluate the sales per head of population. The expansion of reporting to the ward level should improve targeting of interventions and of trade promotions. System development began in May 2008, the pilot began in November of 2009, and national roll out is underway. As of November 2010, 30,000 retailers have been registered and 27,400 remain active. Submitted data is compiled into an online web portal where PSI staff and partners can view trends captured in graphics and maps. PSI has seen increasing enrollment in the program in all regions of Tanzania. Challenges include defining requirement, negotiations with mobile service providers, payment amount, text input difficulties, cost of scratch cards, recruitment of qualified staff in private markets, accuracy of data, and reliance on scalability to provide meaningful data. Looking forward, PSI plans to adjust rewards and incentives, perform SMS surveys, develop new partnerships, and roll out to other health products.

In group discussion, PSI said that programs and demands vary between countries. PSI uses mHealth in India to support reporting by sales staff. SMS is popular among staff in India, while staff in Pakistan prefers paper. As PSI pilots are expanded, a major question is how far down the supply chain can reporting be extended by mobile phone and still provide reliable data. Group comments addressed the need for capacity building in data analysis to prevent information overload as mHealth provides more data flows. It was also commented that users might appreciate messages confirming order status, or positive reinforcement messages from leaders. The point was raised that if perceived utility were great enough, incentives might not be necessary. Regarding sustainability, Margot explained that decreases in incentives have been associated with decreased participation. Scratch cards constitute a significant cost, but prevent misuse of codes for incentives. Group discussion also contrasted the two presented programs. Their various differences include required registration or opt in registration, use of SMS to complement paper or to introduce new reporting to partners, and incentives or oversight for users. It was mentioned that JSI’s mandatory registration fits mandatory reporting requirements in public sector facilities while opt in registration and incentives fit PSI’s private sector retailers. mHealth programs vary to fit the needs of local users, programs and environments.

About the mHealth Working Group

The mHealth Working Group is a collaborative forum for sharing and synthesizing knowledge on mHealth. 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 http://www.k4health.org/toolkits/mhealth.

If you would like to join the mHealth Working Group listserv, please go to http://my.ibpinitiative.org/mhealth. Listserv members are invited to share announcements and materials with the listserv by sending them to .

Meeting Participants, 2/23/11

Name / Organization / Email
Michael Rodriguez / Abt Associates /
Pamela Riley / Abt Associates /
Sandra Kalscheur / AED /
Aleya Horn Kennedy / ARHP /
Jessie Davis / Chemonics /
Kieran Evans / Chemonics /
Laura Raney / FHI /
Cristin Marona / Futures Group /
William Olander / ICFI /
Jordana Huchital / Interactive Outcomes /
James Bon Tempo / Jhpeigeo /
Mohamad Syar / JHU/CCP /
Basil Safi / JHU/CCP /
Arzum Ciloglu / JHU/CCP /
Rebecca Shore / JHU/CCP/K4Health /
Laura O’Donnel / JHU/CCP/K4Health /
Elsie Minja-Mwaniki / JHU/CCP/K4Health /
Angela Nash Mercado / JHU/CCP/K4Health /
Joy Kaminyori / JSI /
Sarah Bergman / JSI /
Andrew Inglis / JSI /
Marasi Mwencha / JSI /
David Haddad / mHealth Alliance /
Piers Bocock / MSH /
Colvin, Charlotte / PATH /
Michelle Wofson / PSI /
Arianna Kuttothara / PSI /
Sarah Robbins-Penniman / PSI /
Mariah Preston / PSI /
Margot Mahannah / PSI /
Madeleine Short Fabic / USAID /
Peggy D'Adamo / USAID /
Kristin Rosella / Women Deliver /
Kelly Keisling / mHealth Working Group /
Amira Roess /
Mwombeki Fabian /

4