We’ve recently given out the certificates of participation for all the Health Extension Workers, midwives and supervisors who have been working with us for the last two years. We really appreciate all the effort and time they have put into making the project a success. Here are a couple of photos of Araya presenting some of the certificates:
Earlier this week one of my research colleagues sent me a spreadsheet with the breakdown for the last 6 months (Sept 2012 to Feb 2013) of how the health workers in our project have been making use of voice, SMS and data on their smartphones. The breakdown looks like this:
The data shows that each health worker (per month) makes approximately 160 mins of voice calls, downloads 27Mb of data and sends 3 SMSs.
Few notes and comments:
- the data was directly from the mobile company – not from any analysis tools/apps installed on the phones, so is about as accurate as we’d ever be able to get
- in the data above I’ve only included the health extension workers and midwives, the supervisors usage is not included (although we have figures for them too)
- we are giving 100 birr top-up per month to each health worker and we don’t restrict what this can be used for
- for the data it’s clear that the the health workers are adding their own top-up balance too (in addition to the 100 birr we give)
What interesting for us is that the health workers are clearly using the data connection for much more than simply submitting the protocol forms and the accessing the mobile scorecard, although at an average of 27Mb per month, this is a long way from the 500Mb+ per month many people in EU/US often get through.
The very low level of text messaging (less than 3 SMSs sent per month) is also very interesting to see. One possible reason for this (and this also came from our baseline survey interviews) was that the health workers don’t use text messaging because they are not confident in using the Latin alphabet, or perhaps they know the recipient of the message cannot read the Latin alphabet, or doesn’t have a Ge’ez capable phone.
There’s a lot more analysis and info we how we can get from this data – especially when we look at matching up usage of the patient management tools and whether increased usage of these tools also corresponds to increased data usage – but we’ll save much of this for our upcoming technical paper.
Over the last few months, alongside the protocol forms the Health Extension Workers (HEWs) are using to record maternal care patient encounters on their smartphones, we have been developing an analytics dashboard to allow HEWs, midwives, their supervisors and the local health bureaus to track the progress of pregnant mothers, their medical & pregnancy risk factors, and a range of key performance indicators.
Providing information back to HEWs and their supervisors about their performance, we hope will help to increase the number of ANC visits according to the recommended schedule, and provide information for local health bureaus to better prioritize resources and training. The current performance indicators include the percentage of ANC visits made on time, number of protocols submitted, PNC visit made on time and immunization records for both mother and baby.
For the HEWs, we can also provide information about the upcoming appointments, deliveries to assist them to plan their time better. Guidelines from the Ethiopian Ministry of Health encourage all pregnant mothers to give birth at local health centres, so we can use the ANC visit information to inform local midwives on expected delivery dates. Local health bureaus and HEW supervisors are able to compare the performance between different health posts or districts.
We are trying to be careful that this doesn’t become used as a EMRS (electronic medical records system) – there are already plenty of MRS’s available – rather we are looking at ways in which the HEWs can see advantages to recording their patient visits on their smartphones, by providing them with relevant, timely and easy to understand information about the patients in their area. In the future we may look at how to integrate with an MRS system (e.g. OpenMRS), but currently this is not the focus of what we’re trying to achieve.
For the technically minded, the analytics dashboard runs by accessing the ODK Aggregate database directly. We’ve looked at several different data collection tools (especially those focused on medical information collection), but all would require either direct database access (as we have done with ODK) or extraction of the data via an API (which would generally mean exporting to another database then accessing the dashboard from this). We’re still in the process of getting the HEWs and their supervisors up and running with accessing all this information via the web application and smartphone – we also still have some development work to do. Currently our researchers in Mekelle are printing regular reports to give to supervisors and HEWs, also, as this is a research project, it’s important that all the information (from protocols) can be stored as a hard-copy with the rest of the normal patient records at the health posts.
We’re currently developing an application so HEWs are able to access their task/performance information directly on the smartphones – which will work offline when there is no GPRS connection available, and update automatically when a connection is available (most likely using an HTML5 application, rather than a specific Android application)
Using a smartphone platform to deliver this type of information is a good balance & compromise between other platform choices we could have made. Using PCs/laptops/netbooks would involve much more technical support, training and maintenance, and likely to have other issues such as access to electricity, portability etc. Smaller, low-spec phones would not allow us to present the information in such a clear and easy-to-use way.
For those interested the code for the analytics dashboard is available to download from GitHub at: https://github.com/alexlittle/Digital-Campus-Analytics
Couple of short videos from our recent HEW training sessions: