Part 4 (recommendations) was posted. Going use this week as we discussed to add/take out in areas as well as use your suggestions from the background and part 2.
Q: yes so with the Mwana project are you focusing at all on prevention of mother to child transmission with mobile phones at all?
at present no.. only focused on results quicker to caregiver, and post-natal care increased, also used for wider management of pediatric care and treatment services as provincial and district health teams have a live web tool where they can monitor what is going on at health facility level, eg. dbs card stockout, where samples are getting stuck etc
we are talking about expanding mwana to focus on maternal health issues antenatally
but not yet developed a system yet
to increase ANC attendance at 14weeks, and 4 focused ANC visits during pregnancy- so of course here counselling for PMTCT, family planning advice, IYCF couselling, drug adherence, counselling and testing etc would be taken into accout
Q: do you know of other preventive projects? using mhealth
in zambia through the mHealth technical working group we have short presentations by partners on new initaitves
but as yet i havent heard any related to prevention in particular
an FHI collaborate was doing a small small project looking at adherence to ARV’s in pregnant women and mothers for PMTCT
Q: Are the communities welcoming to new mhealth developments?
it varies. from our evaluation we saw that for the most part yet i think communities, if they see benefit of a project to themselves, i.e. it assists their work, they see a positive benefitfrom our qualitative study we see community health workers using the system a lot more than health care workers as a communition tool.
Q: as a good form of communication or misuse?
good form. very few cases of misuse, but this goes hand in hand with quite extensive particapatory training and follow-up mentorship into the system we have build in positive feedback mechanisms. e.g. ” thank you for registering a birth loveness bwalya. your contribution is important”we are also in the process of translating all messages and code in zambias 7 main languagesafter mothers registar a birth are they remined to come into the clinic for trimester check ups? (this seems almost a preventive measure if your reminding women of the importance of taking ARVs)
a community health care worker registers a birth in the community or at the facility. the CHW will then get a remidner to ask that mother to come to health facility at 6 days, 6 weeks, and 6 months post natally in line with zambias immunization schedule and to recieve other important health benefits
so its not explicitly for HIV positive mother
if a CHW sees or hears about a birth in their community he or she is trained to register that mother
of course once the mother brings the infant to facility the
the child and mother are offerred both treatment and care services but also preventative services
Q: what kind of preventive services?
is the mother offered
IYCF counselling, family planning counselling and services, Family planning counselling, Check for obstetric complications. Provide nutrition/ IYCF counselling, both for the mother and
child.Check adherence if on ARVs and co-trimoxazole. Check and support disclosure. Check and support couple counselling. Check breast conditions and treat appropriately, if mother HIV positive Start NVP prophylaxis for infant, Family planning counselling and condom promotion. Assess for ART eligibility (WHO clinical staging and/ or
CD4).i can send you our PMTCT national guidelines with procedures at 6 days 6 weeks and 6months many of them are very definately preventative.
Q: and the national goverment has obviously been receptive to this project calling for a national scale up but have they actually gotten things done, or is it all talk? What about the District level goverment, helpful?
well from the projects inception the MoH has been very involved, guided and supported by unicef and partners. we had a national launch last year which was completely led by the government. we have Government engagement and leadership in coordinating provinces and partners for scale- of course all the time supported by partners..
but this has been cardinal in the success of thismoved slower, but with government
Q: were you surprised by there efforts in being supportive?
we are working at present with drawing up a ToR for dedicated MoH mHealth coordinator togetther with government
well the way UNICEF works is hand in hand with government. our work plan every year is dicussed with government and signed off by the permanent secretary. mid term review of our work plan is also done with governemtn..so its somehow a bit of a legally binding documetn
terms of reference
Q: and what next for mwana project?
its hasnt always been easy.. ownership of the project prior to initiation, and coordination among the partners have been challenges as partners wanted to work in silo..but we pushed strongly for coordination. The approaches used to overcome these challenges were to regularly convene the partners to strategize and ensure that there was only one coordinating body, a mHealth technical working group led by the MoH. Also, one joint plan and one common monitoring and evaluation framework were established and reviewed on a regular basis.
Dedicated MoH mHealth coordinator
Regional and national telecon negotiations for competitive pricing
Continued monitoring of the systems as phased scale-up takes place
Plan is to scale to 200 plus facilities by next year
we are also exploring other areas where we can expand mwana
improve access to ANC visits
UNICEF WFP nutrition and mobile delivery and tracking system feasibility study
and with our child protection section pilot decentralized birht registration of newborns in 3 provinces. after scaling for a year we will monitor and possibly do an evaluation of scale
Q: did you have a set guideline for determining if this was successful project? in your view is it successful?
Yes. we did comprehensive qualitative and quantiative evaluation of the pilot
thus the goverment decided to scale
Interview with Donald Thea: Professor of International Health at Boston University. Thea purses a full time career in both domestic and international clinical and epidemiological research in infectious diseases. He is currently the program director of the Boston University preventing mother-to-child transmission of HIV (PMTCT) integration project, which seeks to improve the implementation of PMTCT services and early infant diagnosis services in Southern Zambia.
Background: Thea has spent 25 years in Africa starting in 1989 when he was first went to Congo. He was been working in Zambia since 1999 mostly on HIV and PMTCT. Thea (2012) mentions that this is really the first study that he knows of using mobile technology to improve the health of rural communities and prevent HIV.
– 1st phase is article he wrote.
– 2ned phase will be community health agent who live in the community have an interest in health and doing some work for some pay and volunteer and a lot of them have cell phones. (5 years increase in cell phones). We are these communities with cell phones to register pregnancies and births and maternal and infant deaths. Once the pregnancy is entered and expected date of delivery is entered into the database. The community health workers then get text messages to remind women to come in for visits to the local clinic. This encourages mothers to come in for their first, second and third trimester visits whom may be coming from long distances away. During these visits to the clinic the mother is reminded about the impotence of taking her ARVs for her and her child to encourage a healthy pregnancy and childbirth with the help of prophlaxisis. The community health workers are also using cell phone for maternal morbidity using community counselors in setting up trios center to text health related questions to the clinic to determine if an ambulance is needed for further medical attention.
– Started implementing it and getting (5 health centers) impressive results. 800 pregnancies, deliveries registered in 2 months.
– System was failing from mother to bring in child to get tested for HIV and often mothers would not come back, now women get child tested and get the results quickly which is import as children’s HIV progresses much quicker then adults ARVs are essential.
– What Role is the Government playing? MOH supportive, local ministry of health at the district health was enthusiastic and the national government immediately decided to scale up a national campaign. The National Government is currently seeking non-governmental organizations that are willing to help. Most of the costs come in the training of the people using the system for example the nurses in health facilities and the community workers (whom might already have cell phones) register blood spots and teaching them how to enter pregnancies, expected delivery dates, and text clinics for health related questions.
– Ministry needs to find people to take responsibly for oversight of the program. Organizations and NGOs come in and think of innovative ideas and pilot projects but they often do not go anywhere and becomes inefficient. If there is someone in the MOH that can be the central coordinator then maybe these projects can obtain the correct resources and funding to be implemented properly. They can also attract other resources (if they put it on their list and go to Gates Foundation (who support technology innovations), Norway donates a lot of money to publish health) Implementing guidelines Thea feels is also incredibly important.
– Data collection are also used as well, on tablet
Data retrieved: World Telecommunication/ICT Indicators Database (2012)