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Mobile Technologies
& Community
Case Management
—
—
Solving the Last Mile in Health Care Delivery
Contents                                       Introduction
                                                                                                              1
                                                                                                              —
                                                                                                              —
                                                                                                              Understanding
Understanding Community Case Management        Mobile phones can change the way healthcare is delivered
                                               in the most rural and underserved parts of the world.
4    What is Community Case Management?        There is now a way to have real-time, two-way communi-
5    Community Case Management Challenges      cation with communities that are beyond the periphery of




                                                                                                              Community Case
7    What is a Community Health Worker?        formal health systems.
8    Mobiles & Real-Time Information                A child gets sick in a remote village in Malawi. She is
10   A framework for leveraging the power of   undernourished and there is over a 50 percent chance that
     mobile phones and real-time information   she has either pneumonia, diarrhea or malaria. The nearest




                                                                                                              Management
                                               health clinic is a day’s walk away and her family can barely
                                               afford to take her. A Community Health Worker (a volun-
Workshop                                       teer member of the community, trained to diagnose, treat
                                               and refer) can mean the difference between life and death.
14   Workshop Goals                                 Largely unsupported by the formal health system,
18   Workshop Process                          this Community Health Worker is often unable to make
                                               a timely and accurate diagnosis. One solution to the
                                               disconnectedness, these problems of distance, time, and
Focus Areas                                    access to information, exists in the increasingly ubiqui-
                                               tous mobile phone.
22   Bridging the Gap between Supply                Now, the Community Health Worker can use her
     and Health Groups                         phone to get information, ask advice, re-order life-saving
26   Giving Voice to Demand                    drugs, and receive feedback from the otherwise-distant
30   Building Capacity through Incentives      formal health system. Additionally, these interactions
34   Solution Highlights                       provide vital traces, at a national level, of activities and
36   Design Principles                         needs that were previously impossibly far away, creating
                                               the ability for realtime monitoring and accountability.
                                                    To explore this unique solution-space UNICEF and
40   Participants                              frog brought together public health, mobile health and
42   About                                     design constituencies to create an adaptable model for
                                               how mobile can best support Community Health Work-
                                               ers as they diagnose, treat and refer the most common
                                               killers of children.
Mobile Technologies & Community Case Management




What is Community
Case Management?
To bridge the access gap to basic healthcare, Ministries       Community Case Management Challenges
of Health in developing countries increasingly rely on         “We do not need a new science or new gadget to address the challenges we face
existing front-line community health workers to diagnose,      today. What we need is to remove the bottlenecks that prevent these population
treat and refer children from remote communities with          groups from sustainably accessing essential services.”

common childhood illnesses. Integrated Community Case          —Nicholas Alipui, Director of UNICEF Programmes
Management is a strategy whereby front-line health workers
are trained, supplied, and supervised to deliver treatments    Incentives                    Training                     Monitoring
in the community to children with pneumonia, diarrhea,         Motivating community          Sharing knowledge and        Analyzing and aggregat-
                                                               health workers and citizens   tools to aid Community       ing data to trigger feedback
and malaria and sometimes dysentery, newborn sepsis and        to participate in Commu-      Health Workers and           and dialogue.
acute malnutrition.                                            nity Case Management          increase their capacity to
    Community Case Management is not a new strategy.           services.                     handle Community Case        Supervision
                                                                                             Management services.         Strengthening links
It has existed at small scale for decades and at large scale   Quality of Care                                            between the community
for single diseases for years (such as pneumonia control in    Fostering successful case     Retention                    health worker and health
Nepal). What is new is the priority that global development    management through            Celebrating and recogniz-    system, relying on local
                                                               effective diagnosis, treat-   ing the efforts of Com-      solutions as often as
partners and governments have given to large-scale             ment, referrals, and          munity Health Workers        possible.
adoption of Community Case Management as a critical link       follow-up.                    to foster high morale and
in the healthcare system.                                                                    engagement.


4                                                                                                                                                    5
Mobile Technologies & Community Case Management




                                                  What is a Community
                                                  Health Worker?
                                                                                                                                        he
                                                         ty                                                                               al




                                                        i
                                                      un




                                                                                                                                           th
                                                                                                                                             ca
                                                  comm
                                                                     Educates                               Use as Uno cial
                                                                     Community                            Healthcare Workers




                                                                                                                                               re s
                                                                                                                    Give Continuous




                                                                                                                                                   ystem
                                                                   Gains Respect                                  Healthcare Training


                                                                          Builds
                                                                          Relationships                                    Provide
                                                                                           Community             Simple Incentives
                                                                                          Health Worker



                                                  A Community Health Worker is a trusted member of the community—a mother
                                                  or father, a local farmer or business owner—who serves as the primary link in
                                                  healthcare delivery for many under-served populations. She spends the time she
                                                  has to spare as a healthcare extension worker, creating a crucial bridge between
                                                  the community and the healthcare system. She has recognized the suboptimal
                                                  state of her community’s health, and is motivated by the opportunity to improve
                                                  it. She gains recognition and respect within the community and is rewarded by
                                                  small incentives provided by the healthcare system and NGOs in exchange for her
                                                  extension worker work.
                                                       Through the minimal training she receives from the clinic, NGOs and the
                                                  Ministry of Health, she educates the community on healthcare and health-related
                                                  topics of daily living, like safely preparing food. She sometimes assumes the role
                                                  of healthcare worker, and often helps out around the understaffed clinic with
                                                  record keeping, patient intake and a variety of clerical and clinical duties. Through
                                                  her existing position as a community leader, she is the liaison between the com-
                                                  munity and the clinic, providing medicine, information and enabling transporta-
                                                  tion to clinic visits when necessary.

6                                                                                                                                                          7
Mobile Technologies & Community Case Management




Mobiles & Real-Time
Information
Disparities and inequities are increasing in the world today particularly around
access to health services. How do we remove the bottlenecks that prevent the
most underserved population groups from sustainably accessing essential ser-
vices? One of the key bottlenecks is the ability to know where disparities are the
greatest so that resources can be targeted more effectively.
  The expanded reach of mobile devices and wireless networks may prove to be
valuable tools in improving services. However, in order to increase the impact
of integrated Community Case Management, they must be used in a way that
maximizes their capabilities to provide breadth instead of depth and to capture
every interaction in realtime. UNICEF and its partners are beginning to explore
new ways in which mobile technologies can help them answer these questions
in real-time:

Are we reaching the right people?                 How can we get the few key pieces of
                                                  information we need that can help
What are the returns on our                       programme managers act in time?
investments?

How can we make mid-term course                   Can mobiles help us improve program-
corrections to our programmes based               matic outcomes and increase impact?
on feedback from real time data?                  And how can we engage the people we
                                                  serve in this process?



8                                                                                        9
Mobile Technologies & Community Case Management




A framework for leveraging the                                                                                                                 Conventional Data Flow:
                                                                                                                                               Mobile technologies were originally
                                                                                                                                               viewed as a more efficient means of


power of mobile phones and
                                                                                                                                               data collection, replacing printed
                                                                                                                                               forms. This data was integrated into
                                                                                                                                               existing processes in which informa-


real time information
                                                                                                                                               tion flows in one direction to support
                                                                                                                                               oversight and decision-making.

                                                                                                                                               Simultaneous Data Flow:
                                                                                                                                               Much more powerful results can be
                                                                                                                                               achieved when this data is shared
                                                                                                                                               simultaneously with participants
                                                                                                                                               throughout the ecosystem in a timely
                                                                   Simultaneous Data Flow                                                      manner. Tailored views of the infor-
                                                                                                                                               mation are essential to ensure that the
                                                                                                                      Conventional Data Flow   data is useful to different participants.

                                                                                                                                               Reciprocal Communications:
                                                                                                                                               Engagement between participants is
                                                                                                                                               greatly enhanced by the simple power
                                                                                                                                               of conversation, recognizing the
                                                                                                                                               personal and social nature of mobile

                                                                                                  +                                            phones. Simple forms of feedback and
                                                                                                                                               acknowledgement have been shown
                                                                                                                                               to dramatically increase the use and
                                     Measuring Demand                                                               Country                    appeal of these services.


                                                                                        +       District
                                                                                                                                               Measuring Demand:
                                                                                                                                               Mobile technologies can open up a
                                                                                                                                               dialogue with communities to drive
      Community                                                                                                                                demand for services and monitor needs
        Leaders                                                                        Clinic                                                  across diverse communities allowing
                                                                                                                                               service providers to predict as well as
                                                                                                                                               react to health needs and creating a
                                                                                                                                               positive feedback loop that builds over
                                                                                                                                               all trust in the healthcare system.

                                                             Community Health                                                                  Metrics as a By-Product:
                                                                 Worker                                                                        The most effective metrics can be
                                                                                                             Metrics as By-Product             captured as a by-product of human-
                                                                                                                                               centered design and increased engage-
                                                                                                                                               ment across a range of participants.
                                                                                                                                               Services created with a metrics-first
                                                                                                                                               are often burdensome and alienat-
                                                                                                                                               ing to health workers as they don’t
              Mother
                                                                                                                                               provide any immediate benefits or
              & Child                                                                                                                          acknowledgement for their work.
                                                        Reciprocal Communication
                                                                                                           Global


10                                                                                                                                                                                    11
2 —— —
           How can we apply mobile
           phones and real-time
           information to strengthen

—
—— — —
   ——      —
           —
           community case management?

Workshop   We brought together a
           community of international
           experts in public health
           and mobile technologies to
           answer that question.
Mobile Technologies & Community Case Management




Workshop Goals
A one-day gathering in New York City which brought together key stakeholders
from public health programming and mobile health implementers to build align-
ment around how mobile phones can support the tools, processes and systems
of integrated Community Case Management. The workshop was hosted and
facilitated by frog, a global innovation firm and UNICEF partner. The first order
goal of the workshop was for the two communities to share best practices and
explore innovative ways to integrate mobile technologies into Community Case
Management. This supported the second order goal: to better support com-
munity health workers to serve underserved communities more effectively and
improve key child survival outcomes. In this collaborative and action-oriented
workshop we:

Generated a provisional model for                 Discussed specific local and regional
how the different layers of healthcare            needs in order to integrate the
providers and their user experience               appropriate flexibility for location-
fits together.                                    specific customization.

Identified key opportunities for                  Generated a set of guiding principles
alignment in the planning and                     for enhancing Community Case
prioritization process to support this            Management and the role of the
integrated user experience.                       Community Health Worker through
                                                  mobile technologies.



14                                                                                        15
Mobile Technologies & Community Case Management




16                                                17
Mobile Technologies & Community Case Management



                                                  Workshop Process                             4

                                                     1                                      Concept Generation
                                                                                            From the provocation exercise, each
                                                  Knowledge Shareout                        group created 2 to 4 new concept ideas
                                                  A workshop’s success is driven by the     related to their specific focus area, and
                                                  collective expertise and knowledge        presented them to everyone. Focus
                                                  available in the room. Our first          areas included supply chain, demand
                                                  step was to share successes and           generation and incentives.
                                                  failures from our varied perspectives
                                                  and experiences in healthcare,
                                                  government and technology (and their
                                                  intersections).




                                                     2                                         5

                                                  Scenario Building                         Solution Voting
                                                  Scenarios help envision people using      UNICEF country representatives used
                                                  a future tool or service in a specific    dots to select the concepts they found
                                                  situation. Divided into groups, we        most compelling. The top 6 concepts
                                                  imagined an ideal service or process      were then used as the focus for further
                                                  centered around a specific Community      refinement in the Data Flow Exercise.
                                                  Case Management focus area.




                                                     3                                         6

                                                  Provocation Exercise                      Data Flow Exercise
                                                  Building on our scenarios, we             The goal of this exercise was to
                                                  overlayed perspectives and potential      illustrate the ways in which data flows
                                                  practices inspired by global companies.   back, forth, and between users in the
                                                  How would DHL or Nokia handle             chain of communication. Identifying
                                                  Community Case Management                 users goals, actions and feedback
                                                  challenges?                               illustrated good opportunities for
                                                                                            mobile technologies — as well as
                                                                                            opportunities where other methods
                                                                                            were more appropriate.




18                                                                                                                                19
3 —— —
—
—— — —
   ——
              Bridging the Gap Between Supply and Health Groups

              As Community Health Workers take on responsibility for more front-line care and
              case management, it is critical that they have adequate supplies to support their




              —
              —
              expanded activities. How can we use communication technology to ensure that
              the necessary supplies are available to respond to needs?




Focus Areas   Giving Voice to Demand

              Much of the effort in program planning goes toward the delivery of products and
              services. Community Health Workers are embedded in the communities they
              support, driving program awareness and responding to demands. How can we
              use communication technologies to give a stronger voice to community demand




              —
              —
              for Community Case Management services through Community Health Workers
              on the front line of care?




              Building Capacity through Incentives

              The policies and organizations that support Community Health Workers vary
              tremendously from region to region. Yet in almost every case there is a huge
              challenge in building capacity and rewarding performance in meaningful ways.
              How can communication technologies help us test different forms of recognition
              and reward to improve performance and engagement, particularly as Community
              Health Workers take on more responsibilities for case management?
Mobile Technologies & Community Case Management




Bridging the gap
                                                                                                                     1

                                                                                                                  Community Health Worker
                                                                                                                  Florence is with a mother and her



between supply
                                                                                                                  child. Florence diagnoses the child
                                                                                                                  with malaria and gives the mother
                                                                                                                  anti-malarial drugs. She inputs
                                                                                                                  this transaction and other patient



and health groups
                                                                                                                  information (name, sex, age, address,
                                                                                                                  symptoms) into her mobile phone and
                                                                                                                  sends it to the database.




                                      Patient + Transaction
                                           Information                                                               2
                                                                                              FloREnCE:
                                                                +                             Infant female
                                                                                              diagnosed w/early   Immediately following the input of the
                                                                                              stage malaria
                                                                                                                  transaction into her phone, Florence
                                                                                                                  receives an instant follow-up message
                                                                                              ClInIC: Please
                                                                                              give ACTs (dosage   that states “Thank you for the update.
                                                                                              x for 7 days) and   Please give ACTs (dosage x for 7 days)
                                                                                              then follow up in   and then follow up in 3 days and check
                                                                               Stock Levels   3 days and check
                                                                    District                                      symptoms.”
                                                                                Oct - Nov     symptoms.
                                                                    Manager


                                              +
                                                                               F    J   T


                                                     Clinic
                                                   Supervisor
     Mother
     & Child                                                                                                         3
                  Community
                 Health Worker                                                                                    This transaction data is received and
                                                                                                                  aggregated through a database engine
                                                                                                                  that reports real-time supply stock
                                                                                                                  information back to the District,
                                                  Replenish                    Community
                                                                                 Leaders                          Regional, and National offices. An
                                                                                                                  administrator reviews a dashboard
                                                                                                                  showing stock supplies of various
               Vaccination Stock                                                                                  drugs and vaccines by region. He can
                                                                                                                  easily troubleshoot stock overages and
                                                                                                                  deficiencies, and send action requests

Illustrates Challenges:                                                                                           back to regional offices to reallocate
                                                                                                                  stock between their clinics.

Quality of Care / Monitoring / Supervision / Training

22                                                                                                                                                   23
Mobile Technologies & Community Case Management



                                                     4                                                                   7
                                                                                            ClInIC: Hi Florence,
                                                                                            how is female infant
                                                  This transaction data is simultaneously   doing with anti-malaria   One week later, Florence receives an
                                                  received and incrementally reported to    treatment?                SMS message prompting her to give
                                                  the NGO and public/private sectors to                               an update on the baby to whom she
                                                                                            FloREnCE:
                                                  inform them of stock usages.              Healthy baby :)           prescribed the anti-malarial drug. Did
                                                                                                                      the treatment work?
                                                                                            ClInIC: Great news!
                                                                                                                      Florence inputs a follow-up response,
                                                                                                                      which is again cycled back into the
                                                                                                                      system and she receives a friendly
                                                                                                                      message back acknowledging receipt of
                                                                                                                      the information and thanking her for
                                                                                                                      her continued work in the community.




                                                     5                                                                   8

     DISTRICT MGR:
     Administered
                                                  Meanwhile, Florence’s local clinic is                               The data is fed back from the District
     AMM Oct-Nov –                                low on malarial drugs. They receive                                 Manager to the community. He sends
     Florence 16;                                 a proactive update via SMS that a                                   an SMS message to the Village Health
     Joe 37; Tom 6;
     Fennis 21
                                                  new shipment is on its way. They                                    Committee Leader with positive stats:
                                                  also receive a report that Joe has been                             “76 children got healthier from seeing
                                                  administering a higher percentage of                                a Community Health Worker or clinic
                                                  anti-malarial drugs compared to the                                 in your village this month.”
                                                  other Community Health Workers in
                                                  the district.                                                       Joe receives the same message with
                                                                                                                      positive affirmation of his work to
                                                                                                                      help the children in his community.




                                                     6                                                                   9

                                                  The clinic Supervisor goes to meet                                  The Village Health Committee in turn
                                                  with Joe in person. He intervenes by                                relays this information back to their
                                                  reviewing diagnostic steps to ensure                                community via word of mouth.
                                                  that he is not overlooking other             DISTRICT MGR:
                                                                                               76 children got
                                                  conditions.                                  better after
                                                                                               seeing CHW in
                                                  He also proactively brings with him          your village!

                                                  new supplies based on reporting of his
                                                  other drug supply levels.




24                                                                                                                                                          25
Mobile Technologies & Community Case Management




Giving voice to
                                                                                                                                                          1

                                                                                                                                                       In Village X, members of the Village
                                                                                                                                                       Health Committee hear from a local



demand
                                                                                                                                                       woman that a Community Health
                                                                                                                                                       Worker referred her child to the
                                                                                                                                                       nearest clinic, but it is too far and
                                                                                                                                                       expensive for her to travel.

                                                                                                                                                       The Village Health Committee
                                                                                                                                                       members note that this is a continuing
                                                                                                                                                       problem that has prevented the
                                                                                                                                                       children in the village from receiving
                                                             “Lack of                                                                                  proper treatment.
                                                          Transportation”


                                                                                                                                                          2
                                                                                                 HoTlInE:
                                              Community                                          Issues with access
                                                Leaders                                          to healthcare?                                        Periodically, the leader of the Village
                                                                                                 [1] None                                              Health Committee receives an SMS
                                                                                                 [2] No education
                                                                                                 [3] Transportation
                                                                                                                                                       text stating they can report concerns
                                                                                                     to clinic                                         or issues to the district manager
                                                                                                 [4] No supplies                                       Hotline. He is provided a series of
                                                       “Low Referral
                                                       Attendance”                                                                                     prompts via SMS to rapidly record the
                                                                                                 VIllAGE:
  Community                                                                                                                                            concern.
                                                                                                 [3] Transportation
 Health Workers                                                                                      to clinic


                                          +
                                                                                                                                                       The prompt provides a list of common
                                                                                                                                                       problems that reduce the quality of
                                                                                                                                                       care. He selects “#3 Transportation to
                                                                                                                                                       clinic” as a major issue.
CLINIC
 10km
                                                                        HO
                                                                          TLI
                                                                             NE
                                              Clinic
                                              Nurse                                          +                                                            3
                                                                                                  HoTlInE:                         nURSE:
                                                                                                  How are things at your clinic?   [3] Low referrals
                                                                                                  [1] Okay                                             Meanwhile at the nearest clinic, a
                                                                                                  [2] Too busy                                         Nurse is also prompted via SMS
                                                                                                  [3] Low referrals                                    message to take a poll survey on “How
                                                                                  District                                                             are things at the clinic?”
                                                                                  Manager
                        Subsidized
                                                                                                                                                       She selects “#3 Low referrals” from a
                   Clinic Transporation
                                                                                                                                                       list of common or recurring issues.




Illustrates Challenges:
Incentives / Quality of Care / Monitoring

26                                                                                                                                                                                             27
Mobile Technologies & Community Case Management



                                                                        4                                                             7

                                                                     The Village Health Committee leader                           A text is sent to the Village Health
     VIllAGE:                                        nURSE:          and Nurse both receive an SMS                                 Committee in Village X letting them
     Transportation                                  Low referrals   message immediately thanking them                             know that transportation to the clinic
     to clinic                                                       for using the Hotline. It also explains                       will now be supported through the
                                                                     that their concerns will be reviewed                          new taxi program.
                                                                     and a status update will be provided in
                                                                     one week.




                        HoTlInE: Looking for a
                        solution for your problems




                                                                        5                                                             8

                                                                     Administrators at District and                                The Village Health Committee shares
                                                                     National levels view aggregated                               the news of transportation to the clinic
                                                                     hotline and poll data to troubleshoot                         with their village via word of mouth.
                                                                     areas. They review top unmet needs,
                                                                                                                 HoTlInE:
                                                                     such as clinic access, and quality of
                                                                                                                 We will provide
                                                                     service trending data for Community         your village
                                                                     Health Workers.                             with low-cost
                                                                                                                 alternative
                                                                                                                 transportation
                                                                     They pinpoint a problem with high           to the clinic
                                                                     referrals reported, but patient atten-
                                                                     dance in clinics and hospitals is low
                                                                     across the region.




                                                                        6

                                                                     At the national level they realize that
                                                                     the root of many problems for Village
                                                                     X, including perceived quality of
                                                                     health services, is lack of access to the
                                                                     clinic.

                                                                     They send a note to the Regional
                                                                     Manager to work with local taxi
                                                                     drivers in Village X to help with
                                                                     transportation issues.




28                                                                                                                                                                      29
Mobile Technologies & Community Case Management




Building capacity
                                                                                                      1

                                                                                                   Community Health Worker
                                                                                                   transactions with villagers are



through incentives
                                                                                                   being recorded and tracked by the
                                                                                                   Community Case Management
                                                                                                   database engine.

                                                                                                   Florence, a Community Health
                                                                                                   Worker, is directly linked with the
                                                                                                   percentage of increasing demand
                                                                                                   for regular checkups and treatments in
                                                                                                   her community.

                  “Florence is great!”                  76 malaria
                                                  29 pneumonia patients
                                                         treated
                                                                                      Florence
                                                                                                      2

                                                                                                   Citizens of Village X are able to rate
                                                                                                   the performance of their Community

            Mother
                                                                    +                Aug Sep Oct   Health Workers via SMS, providing
                                                                                                   qualitative information about the
            & Child                                                                                responsiveness and quality of care
                                                                                                   they are receiving.



                                                                          District
                                                                          Manager
                                $   $
                                $


 Community                  Rewards
Health Worker                                                        “Florence is doing
                                                                        a great job.”                 3

                                                                                                   Florence is noted as being a high-
                                                                                                   performing Community Health
                                                                                                   Worker from both number of
                Community
                                                                                                   transactions and feedback from actual
                  Praise
                                                                                                   patients. The clinic and district office
                                                    Community
                                                     Members                                       gets a report on these high performing
                                                                                                   Community Health Workers on a
                                                                                                   regular basis.



Illustrates Challenges:
Incentives / Training / Retention / Monitoring

30                                                                                                                                       31
Mobile Technologies & Community Case Management



                                                                   4                                          7

                                                                The district office sends a message to     At incremental periods throughout
                                                                the Village Health Committee, and          the year, they reward a set of high
                                                                directly to Florence, with positive        performing Community Health
                                                                feedback and her stats: “Florence has      Workers delivered in the form
                                                                treated 29 cases of pneumonia and her      of money, new mobile phones, or
                                                                patients have given her a 99% approval     resources for training.
                                                                rating.”

      DISTRICT MGR:                        DISTRICT MGR:
      Great job Florence!                  Your CHW, Florence
      You have helped 29                   has helped 29
      pneumonia patients                   pneumonia patients
      this year                            in your community




                                                                   5                                          8

                                                                The Village Health Committee puts          Florence is empowered to train
                                                                together a local ceremony and provides     another village member as a
                                                                her with a Community Health Worker         Community Health Worker to
                                                                badge of excellence. This in turn builds   assist her in her duties. She acts as a
                                                                more trust for Community Case              mentor and now both of them can
                                                                Management among the villagers.            handle the increasing number of cases
                                                                                                           in their village.




                                                                   6

                                                                Meanwhile, the District office tracking
                                                                high-performance Community Health
                                                                Workers in their villages. They have a
                                                                special fund set aside for incentivizing
                                                                the highest performers.




32                                                                                                                                               33
Mobile Technologies & Community Case Management




Solution Highlights
1: Bridging the gap between                       2: Giving voice to demand              3: Building capacity through incentives
supply and health groups
                                                  Instant SMS feedback collected         Performance tracking enabled at
SMS data collection at point of                   at the community and clinic levels     individual and district levels
transaction to increase accuracy of               leading to increased demand and
stock level reporting                             quality reporting                      Capturing and tracking data at point
                                                                                         of transactions that link Community
Real-time feedback to clinics,                    Aggregation of demand-based data       Health Workers with patient outcomes
Community Health Workers, village                 from clinics and community, enabling
leaders and community on status                   quicker troubleshooting from           Enabling 2-way communications and
of actions                                        program management                     ratings directly from citizens

Distributed reporting of supply                   Real-time feedback to clinics,         Real-time feedback that prompts
levels and drug efficacy, allowing                Community Health Workers, village      motivation and behavior change for
for proactive planning and local and              leaders and community on status        Community Health Workers
national levels                                   of actions
                                                                                         Accelerated Community Health
Reduced restock supply cycles based               Faster reporting of concerns and       Worker improvement and mentorship
on real demand                                    issues that might not have otherwise   enablement
                                                  been identified
                                                                                         Improving community trust for Com-
                                                                                         munity Health Workers through better
                                                                                         alliance with Village Health Committee

34                                                                                                                                 35
Mobile Technologies & Community Case Management




Design Principles
These principles emerged as a result              Design for the Person                       Consider that Technology Changes         Motivate the Private Sector
of the exercises and workshop.                    Design for people, rather than for the      Much Faster than the Health Domain       Private sector partners are great, but
                                                  system. Designing for people and            Design for the ideal, and trust the      consider their incentives to invest.
Set Boundaries and Scope                          their everyday interactions assures         technology to fill in. Technology        What is there to gain in the health
When choosing areas for mobile                    that you will uncover and solve for the     changes rapidly, while the health        domain or technology sector? Who
technology application, focus on the              right problems.                             sector is much more slow to change.      might the big partners be?
interactions that will be best enabled                                                        When designing for mobile, you have
and enhanced with mobile. Setting                 Consider Value of Efficiencies              to remember that by the time you         Embrace Collaboration
boundaries for the solution prevents              Create communications efficiencies in       design a system, features or capabili-   Foster “communities of practice” or
overcomplicating or overburdening                 and across your organization. Rather        ties might have already changed in       ad hoc sharing networks within UNI-
the system.                                       than forcing hierarchical, linear chains    the market.                              CEF and its partners. Share knowl-
                                                  of communications, look for overlaps                                                 edge of initiatives and pilots, what’s
Apply Mobile Where Appropriate                    in data that can be distilled for differ-   Design for Flexibility and Reciprocity   working or not, build on and leverage
Mobile is not a panacea—it has big                ent points in the system.                   Design for 2-way communications.         existing systems, bundle different
benefits for some interactions, but in                                                        Keep in mind the need for flexibility    pilots together in larger rollouts.
some cases analog might actually                  Consider Scale from the Outset              and reciprocity of communications
still be best. Mobile is a tool, not the          Think about creating solutions that         (e.g. if you pull knowledge from a
total solution.                                   can be used elsewhere, that can grow        community, you should push back
                                                  with technology, that can take on           information to that same community).
                                                  more participants. In other words,          Mobile is great at both of these.
                                                  don’t design yourself into a corner




36                                                                                                                                                                          37
Mobile Technologies & Community Case Management




“The work you are doing gives us the opportunity to answer
 these important questions in real-time. Fast enough to
 impact how we manage our programmes, report to our
 donors, and have a direct effect on the lives of children.”

— Nicholas Alipui, Director of UNICEF Programmes



“We have taken for granted that [because the problems are
 complicated,] the solutions are going to be complicated.
 But simple things can go a long way. ”

— Bernard Kasawa, UNICEF Coordinator MNCH/PMTCT
Initiative Luapula Province, Zambia



The principles and recommendations                improve the quality of outcomes and
in this report serve as guidance for 190          empower communities health workers
UNICEF country offices as they inte-              around the world.
grate real-time monitoring and mobile
technologies into their programming to

38                                                                                      39
Mobile Technologies & Community Case Management




Participants
Aaltje Camielle noordam          Denise Gershbein                       Gabriele Fontana                    Julia Kim                           Merrick Schaefer                     Sarah Anderson
Health Officer, Health Section   Creative Director                      Health Specialist, Health Section   Knowledge Management, Health        Tech 4 Dev Specialist                Country Technical Manager
UNICEF New York                  frog                                   UNICEF New York                     UNICEF New York                     UNICEF Zambia and World Bank         JSI

Alex Harsha                      Donna Espeut                           Garrett Mehl                        Julianna lindsey                    neal lesh                            Scott Ratzan
Field Project Manager            Deputy Director                        Scientist, Department of            Chief Advocacy Communication,       Chief Strategy Officer               Vice President, Global Health
Medic Mobile                     Concern Worldwide                      Reproductive Health and Research    Monitoring and Analysis             Dimagi                               Johnson and Johnson
                                                                        WHO                                 UNICEF Ghana
Alicia lin Fabiano               Dyness Kasungami                                                                                               nicolas oliphant                     Sean Blaschke
Johnson and Johnson              Technical Team Leader, Child Health    Heather laGarde                     Kajsa Westman                       Health Specialist, Health Section    Tech4Dev Specialist
                                 Maternal and Child Health Integrated   Director, Special Programs          Industrial Designer                 UNICEF New York                      UNICEF Uganda
Allison Green                    Program (MCHIP)                        IntraHealth                         frog
Senior Strategist                                                                                                                               nicolas osbert                       Stephanie Dolan
frog                             Eric Swedberg                          J F Grossen                         Khassoum Diallo                     Chief, WASH                          Program Manager, Malaria and
                                 Senior Director, Child Health          Creative Director                   UNICEF WCARO                        UNICEF Mali                          Child Survival Department
Alyssa Sharkey                   and Nutrition                          frog                                                                                                         PSI
Health Specialist                Save the Children, USA                                                     Kumanan Rasanathan                  Patricia Mechael
UNICEF New York                                                         Jaleen Francois                     Knowledge Management, Health        Executive Director                   Texas Zamisiya
                                 Erica Kochi                            Marketing Manager                   UNICEF New York                     mHealth Alliance                     UNICEF Malawi
Amy Ginsburg                     Tech Innovation Specialist             frog
PATH                             UNICEF New York                                                            Marc Mitchell                       Robert Johnston                      Tom Manning
                                                                        Jonathan Payne                      CEO                                 Regional Advisor, Nutrition, WCARO   Principal Designer
Anirban Chatterjee               Esther Ahn                             Partners in Health                  D-Tree                              UNICEF Western and Central Africa    frog
Chief of Health and Nutrition    Associate Creative Director                                                                                    Regional Office
UNICEF Ghana                     frog                                   Jorge Just                          Mariame Sylla                                                            Troy Jacobs
                                                                        RapidFTR coordinator                Regional Health Specialist, WCARO   Robert Fabricant                     Child Health & Pediatric
Brigitte Pedro                   Flavia Mpanga Kaggwa                   UNICEF Protection                   UNICEF Western and Central Africa   Vice President, Creative             HIV/AIDS Advisor
WASH E&M Specialist              ICCM Health Specialist                                                     Regional Office                     frog                                 USAID
UNICEF DRC                       UNICEF Uganda                          Joshua Harvey
                                                                        Senior Associate, Integrated        Mark Young                          Sandhya Rao
Catherine Sun                    Friday nwaigwe                         Partnerships                        Senior Health Specialist,           Senior Advisor for Private Sector
Associate Creative Director      UNICEF Rwanda                          U.S. Fund for UNICEF                Health Section                      Partnerships
frog                                                                                                        UNICEF New York                     USAID




40                                                                                                                                                                                                                   41
Mobile Technologies & Community Case Management




About UnICEF                                                About Mobile Mandate
UNICEF works in 190 countries and territories to help       Mobile Mandate is a collaborative platform that amplifies
children survive and thrive, from early childhood through   the positive social impact of mobile technologies through
adolescence. The world’s largest provider of vaccines for   the transformative power of design. Mobile Mandate
developing countries, UNICEF supports child health          leverages the skills, talents, and capabilities of frog and
and nutrition, good water and sanitation, quality basic     Aricent to bring about positive change in the world
education for all boys and girls, and the protection of     through the exploration of innovative models for service
children from violence, exploitation, and AIDS. UNICEF      delivery. UNICEF’s Tech4Dev organization is a signature
is funded entirely by the voluntary contributions of        Mobile Mandate partner on a number of programs
individuals, businesses, foundations and governments.       including Project Mwana, an mHealth initiative to
                                                            strengthen health services for mothers and infants in East
www.unicef.org                                              Africa. Other Mobile Mandate programs include Project
                                                            Masiluleke, an mHealth initiative to battle AIDS in South
                                                            Africa; Movirtu, a phone-sharing system in Kenya; as
About frog                                                  well as Mobile Money Afghanistan, a research project that
                                                            investigates the use of mobile phones for noninstitutional
frog works with the world’s leading companies, helping      banking in Afghanistan.
them to design, engineer, and bring to market meaningful
products and services. With an interdisciplinary team       mobilemandate.frogdesign.com
of more than 1,600 designers, strategists, and software
engineers, frog delivers connected experiences that
span multiple technologies, platforms, and media.
Clients include Disney, GE, HP, Intel, Microsoft, MTV,
Qualcomm, Siemens, and many other Fortune 500
brands. Founded in 1969, frog is headquartered in San
Francisco, with locations in Amsterdam, Austin, Boston,
Chennai, Bangalore, Gurgaon, Johannesburg, Kiev, Milan,
Munich, New York, Seattle, Shanghai, and Vinnitsa. frog
is a company of the Aricent Group, a global innovation
and technology services firm.

www.frogdesign.com




42

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frog and UNICEF Collaborate on Mobile Technologies and Community Case Management

  • 1. Mobile Technologies & Community Case Management — — Solving the Last Mile in Health Care Delivery
  • 2. Contents Introduction 1 — — Understanding Understanding Community Case Management Mobile phones can change the way healthcare is delivered in the most rural and underserved parts of the world. 4 What is Community Case Management? There is now a way to have real-time, two-way communi- 5 Community Case Management Challenges cation with communities that are beyond the periphery of Community Case 7 What is a Community Health Worker? formal health systems. 8 Mobiles & Real-Time Information A child gets sick in a remote village in Malawi. She is 10 A framework for leveraging the power of undernourished and there is over a 50 percent chance that mobile phones and real-time information she has either pneumonia, diarrhea or malaria. The nearest Management health clinic is a day’s walk away and her family can barely afford to take her. A Community Health Worker (a volun- Workshop teer member of the community, trained to diagnose, treat and refer) can mean the difference between life and death. 14 Workshop Goals Largely unsupported by the formal health system, 18 Workshop Process this Community Health Worker is often unable to make a timely and accurate diagnosis. One solution to the disconnectedness, these problems of distance, time, and Focus Areas access to information, exists in the increasingly ubiqui- tous mobile phone. 22 Bridging the Gap between Supply Now, the Community Health Worker can use her and Health Groups phone to get information, ask advice, re-order life-saving 26 Giving Voice to Demand drugs, and receive feedback from the otherwise-distant 30 Building Capacity through Incentives formal health system. Additionally, these interactions 34 Solution Highlights provide vital traces, at a national level, of activities and 36 Design Principles needs that were previously impossibly far away, creating the ability for realtime monitoring and accountability. To explore this unique solution-space UNICEF and 40 Participants frog brought together public health, mobile health and 42 About design constituencies to create an adaptable model for how mobile can best support Community Health Work- ers as they diagnose, treat and refer the most common killers of children.
  • 3. Mobile Technologies & Community Case Management What is Community Case Management? To bridge the access gap to basic healthcare, Ministries Community Case Management Challenges of Health in developing countries increasingly rely on “We do not need a new science or new gadget to address the challenges we face existing front-line community health workers to diagnose, today. What we need is to remove the bottlenecks that prevent these population treat and refer children from remote communities with groups from sustainably accessing essential services.” common childhood illnesses. Integrated Community Case —Nicholas Alipui, Director of UNICEF Programmes Management is a strategy whereby front-line health workers are trained, supplied, and supervised to deliver treatments Incentives Training Monitoring in the community to children with pneumonia, diarrhea, Motivating community Sharing knowledge and Analyzing and aggregat- health workers and citizens tools to aid Community ing data to trigger feedback and malaria and sometimes dysentery, newborn sepsis and to participate in Commu- Health Workers and and dialogue. acute malnutrition. nity Case Management increase their capacity to Community Case Management is not a new strategy. services. handle Community Case Supervision Management services. Strengthening links It has existed at small scale for decades and at large scale Quality of Care between the community for single diseases for years (such as pneumonia control in Fostering successful case Retention health worker and health Nepal). What is new is the priority that global development management through Celebrating and recogniz- system, relying on local effective diagnosis, treat- ing the efforts of Com- solutions as often as partners and governments have given to large-scale ment, referrals, and munity Health Workers possible. adoption of Community Case Management as a critical link follow-up. to foster high morale and in the healthcare system. engagement. 4 5
  • 4. Mobile Technologies & Community Case Management What is a Community Health Worker? he ty al i un th ca comm Educates Use as Uno cial Community Healthcare Workers re s Give Continuous ystem Gains Respect Healthcare Training Builds Relationships Provide Community Simple Incentives Health Worker A Community Health Worker is a trusted member of the community—a mother or father, a local farmer or business owner—who serves as the primary link in healthcare delivery for many under-served populations. She spends the time she has to spare as a healthcare extension worker, creating a crucial bridge between the community and the healthcare system. She has recognized the suboptimal state of her community’s health, and is motivated by the opportunity to improve it. She gains recognition and respect within the community and is rewarded by small incentives provided by the healthcare system and NGOs in exchange for her extension worker work. Through the minimal training she receives from the clinic, NGOs and the Ministry of Health, she educates the community on healthcare and health-related topics of daily living, like safely preparing food. She sometimes assumes the role of healthcare worker, and often helps out around the understaffed clinic with record keeping, patient intake and a variety of clerical and clinical duties. Through her existing position as a community leader, she is the liaison between the com- munity and the clinic, providing medicine, information and enabling transporta- tion to clinic visits when necessary. 6 7
  • 5. Mobile Technologies & Community Case Management Mobiles & Real-Time Information Disparities and inequities are increasing in the world today particularly around access to health services. How do we remove the bottlenecks that prevent the most underserved population groups from sustainably accessing essential ser- vices? One of the key bottlenecks is the ability to know where disparities are the greatest so that resources can be targeted more effectively. The expanded reach of mobile devices and wireless networks may prove to be valuable tools in improving services. However, in order to increase the impact of integrated Community Case Management, they must be used in a way that maximizes their capabilities to provide breadth instead of depth and to capture every interaction in realtime. UNICEF and its partners are beginning to explore new ways in which mobile technologies can help them answer these questions in real-time: Are we reaching the right people? How can we get the few key pieces of information we need that can help What are the returns on our programme managers act in time? investments? How can we make mid-term course Can mobiles help us improve program- corrections to our programmes based matic outcomes and increase impact? on feedback from real time data? And how can we engage the people we serve in this process? 8 9
  • 6. Mobile Technologies & Community Case Management A framework for leveraging the Conventional Data Flow: Mobile technologies were originally viewed as a more efficient means of power of mobile phones and data collection, replacing printed forms. This data was integrated into existing processes in which informa- real time information tion flows in one direction to support oversight and decision-making. Simultaneous Data Flow: Much more powerful results can be achieved when this data is shared simultaneously with participants throughout the ecosystem in a timely Simultaneous Data Flow manner. Tailored views of the infor- mation are essential to ensure that the Conventional Data Flow data is useful to different participants. Reciprocal Communications: Engagement between participants is greatly enhanced by the simple power of conversation, recognizing the personal and social nature of mobile + phones. Simple forms of feedback and acknowledgement have been shown to dramatically increase the use and Measuring Demand Country appeal of these services. + District Measuring Demand: Mobile technologies can open up a dialogue with communities to drive Community demand for services and monitor needs Leaders Clinic across diverse communities allowing service providers to predict as well as react to health needs and creating a positive feedback loop that builds over all trust in the healthcare system. Community Health Metrics as a By-Product: Worker The most effective metrics can be Metrics as By-Product captured as a by-product of human- centered design and increased engage- ment across a range of participants. Services created with a metrics-first are often burdensome and alienat- ing to health workers as they don’t Mother provide any immediate benefits or & Child acknowledgement for their work. Reciprocal Communication Global 10 11
  • 7. 2 —— — How can we apply mobile phones and real-time information to strengthen — —— — — —— — — community case management? Workshop We brought together a community of international experts in public health and mobile technologies to answer that question.
  • 8. Mobile Technologies & Community Case Management Workshop Goals A one-day gathering in New York City which brought together key stakeholders from public health programming and mobile health implementers to build align- ment around how mobile phones can support the tools, processes and systems of integrated Community Case Management. The workshop was hosted and facilitated by frog, a global innovation firm and UNICEF partner. The first order goal of the workshop was for the two communities to share best practices and explore innovative ways to integrate mobile technologies into Community Case Management. This supported the second order goal: to better support com- munity health workers to serve underserved communities more effectively and improve key child survival outcomes. In this collaborative and action-oriented workshop we: Generated a provisional model for Discussed specific local and regional how the different layers of healthcare needs in order to integrate the providers and their user experience appropriate flexibility for location- fits together. specific customization. Identified key opportunities for Generated a set of guiding principles alignment in the planning and for enhancing Community Case prioritization process to support this Management and the role of the integrated user experience. Community Health Worker through mobile technologies. 14 15
  • 9. Mobile Technologies & Community Case Management 16 17
  • 10. Mobile Technologies & Community Case Management Workshop Process 4 1 Concept Generation From the provocation exercise, each Knowledge Shareout group created 2 to 4 new concept ideas A workshop’s success is driven by the related to their specific focus area, and collective expertise and knowledge presented them to everyone. Focus available in the room. Our first areas included supply chain, demand step was to share successes and generation and incentives. failures from our varied perspectives and experiences in healthcare, government and technology (and their intersections). 2 5 Scenario Building Solution Voting Scenarios help envision people using UNICEF country representatives used a future tool or service in a specific dots to select the concepts they found situation. Divided into groups, we most compelling. The top 6 concepts imagined an ideal service or process were then used as the focus for further centered around a specific Community refinement in the Data Flow Exercise. Case Management focus area. 3 6 Provocation Exercise Data Flow Exercise Building on our scenarios, we The goal of this exercise was to overlayed perspectives and potential illustrate the ways in which data flows practices inspired by global companies. back, forth, and between users in the How would DHL or Nokia handle chain of communication. Identifying Community Case Management users goals, actions and feedback challenges? illustrated good opportunities for mobile technologies — as well as opportunities where other methods were more appropriate. 18 19
  • 11. 3 —— — — —— — — —— Bridging the Gap Between Supply and Health Groups As Community Health Workers take on responsibility for more front-line care and case management, it is critical that they have adequate supplies to support their — — expanded activities. How can we use communication technology to ensure that the necessary supplies are available to respond to needs? Focus Areas Giving Voice to Demand Much of the effort in program planning goes toward the delivery of products and services. Community Health Workers are embedded in the communities they support, driving program awareness and responding to demands. How can we use communication technologies to give a stronger voice to community demand — — for Community Case Management services through Community Health Workers on the front line of care? Building Capacity through Incentives The policies and organizations that support Community Health Workers vary tremendously from region to region. Yet in almost every case there is a huge challenge in building capacity and rewarding performance in meaningful ways. How can communication technologies help us test different forms of recognition and reward to improve performance and engagement, particularly as Community Health Workers take on more responsibilities for case management?
  • 12. Mobile Technologies & Community Case Management Bridging the gap 1 Community Health Worker Florence is with a mother and her between supply child. Florence diagnoses the child with malaria and gives the mother anti-malarial drugs. She inputs this transaction and other patient and health groups information (name, sex, age, address, symptoms) into her mobile phone and sends it to the database. Patient + Transaction Information 2 FloREnCE: + Infant female diagnosed w/early Immediately following the input of the stage malaria transaction into her phone, Florence receives an instant follow-up message ClInIC: Please give ACTs (dosage that states “Thank you for the update. x for 7 days) and Please give ACTs (dosage x for 7 days) then follow up in and then follow up in 3 days and check Stock Levels 3 days and check District symptoms.” Oct - Nov symptoms. Manager + F J T Clinic Supervisor Mother & Child 3 Community Health Worker This transaction data is received and aggregated through a database engine that reports real-time supply stock information back to the District, Replenish Community Leaders Regional, and National offices. An administrator reviews a dashboard showing stock supplies of various Vaccination Stock drugs and vaccines by region. He can easily troubleshoot stock overages and deficiencies, and send action requests Illustrates Challenges: back to regional offices to reallocate stock between their clinics. Quality of Care / Monitoring / Supervision / Training 22 23
  • 13. Mobile Technologies & Community Case Management 4 7 ClInIC: Hi Florence, how is female infant This transaction data is simultaneously doing with anti-malaria One week later, Florence receives an received and incrementally reported to treatment? SMS message prompting her to give the NGO and public/private sectors to an update on the baby to whom she FloREnCE: inform them of stock usages. Healthy baby :) prescribed the anti-malarial drug. Did the treatment work? ClInIC: Great news! Florence inputs a follow-up response, which is again cycled back into the system and she receives a friendly message back acknowledging receipt of the information and thanking her for her continued work in the community. 5 8 DISTRICT MGR: Administered Meanwhile, Florence’s local clinic is The data is fed back from the District AMM Oct-Nov – low on malarial drugs. They receive Manager to the community. He sends Florence 16; a proactive update via SMS that a an SMS message to the Village Health Joe 37; Tom 6; Fennis 21 new shipment is on its way. They Committee Leader with positive stats: also receive a report that Joe has been “76 children got healthier from seeing administering a higher percentage of a Community Health Worker or clinic anti-malarial drugs compared to the in your village this month.” other Community Health Workers in the district. Joe receives the same message with positive affirmation of his work to help the children in his community. 6 9 The clinic Supervisor goes to meet The Village Health Committee in turn with Joe in person. He intervenes by relays this information back to their reviewing diagnostic steps to ensure community via word of mouth. that he is not overlooking other DISTRICT MGR: 76 children got conditions. better after seeing CHW in He also proactively brings with him your village! new supplies based on reporting of his other drug supply levels. 24 25
  • 14. Mobile Technologies & Community Case Management Giving voice to 1 In Village X, members of the Village Health Committee hear from a local demand woman that a Community Health Worker referred her child to the nearest clinic, but it is too far and expensive for her to travel. The Village Health Committee members note that this is a continuing problem that has prevented the children in the village from receiving “Lack of proper treatment. Transportation” 2 HoTlInE: Community Issues with access Leaders to healthcare? Periodically, the leader of the Village [1] None Health Committee receives an SMS [2] No education [3] Transportation text stating they can report concerns to clinic or issues to the district manager [4] No supplies Hotline. He is provided a series of “Low Referral Attendance” prompts via SMS to rapidly record the VIllAGE: Community concern. [3] Transportation Health Workers to clinic + The prompt provides a list of common problems that reduce the quality of care. He selects “#3 Transportation to clinic” as a major issue. CLINIC 10km HO TLI NE Clinic Nurse + 3 HoTlInE: nURSE: How are things at your clinic? [3] Low referrals [1] Okay Meanwhile at the nearest clinic, a [2] Too busy Nurse is also prompted via SMS [3] Low referrals message to take a poll survey on “How District are things at the clinic?” Manager Subsidized She selects “#3 Low referrals” from a Clinic Transporation list of common or recurring issues. Illustrates Challenges: Incentives / Quality of Care / Monitoring 26 27
  • 15. Mobile Technologies & Community Case Management 4 7 The Village Health Committee leader A text is sent to the Village Health VIllAGE: nURSE: and Nurse both receive an SMS Committee in Village X letting them Transportation Low referrals message immediately thanking them know that transportation to the clinic to clinic for using the Hotline. It also explains will now be supported through the that their concerns will be reviewed new taxi program. and a status update will be provided in one week. HoTlInE: Looking for a solution for your problems 5 8 Administrators at District and The Village Health Committee shares National levels view aggregated the news of transportation to the clinic hotline and poll data to troubleshoot with their village via word of mouth. areas. They review top unmet needs, HoTlInE: such as clinic access, and quality of We will provide service trending data for Community your village Health Workers. with low-cost alternative transportation They pinpoint a problem with high to the clinic referrals reported, but patient atten- dance in clinics and hospitals is low across the region. 6 At the national level they realize that the root of many problems for Village X, including perceived quality of health services, is lack of access to the clinic. They send a note to the Regional Manager to work with local taxi drivers in Village X to help with transportation issues. 28 29
  • 16. Mobile Technologies & Community Case Management Building capacity 1 Community Health Worker transactions with villagers are through incentives being recorded and tracked by the Community Case Management database engine. Florence, a Community Health Worker, is directly linked with the percentage of increasing demand for regular checkups and treatments in her community. “Florence is great!” 76 malaria 29 pneumonia patients treated Florence 2 Citizens of Village X are able to rate the performance of their Community Mother + Aug Sep Oct Health Workers via SMS, providing qualitative information about the & Child responsiveness and quality of care they are receiving. District Manager $ $ $ Community Rewards Health Worker “Florence is doing a great job.” 3 Florence is noted as being a high- performing Community Health Worker from both number of Community transactions and feedback from actual Praise patients. The clinic and district office Community Members gets a report on these high performing Community Health Workers on a regular basis. Illustrates Challenges: Incentives / Training / Retention / Monitoring 30 31
  • 17. Mobile Technologies & Community Case Management 4 7 The district office sends a message to At incremental periods throughout the Village Health Committee, and the year, they reward a set of high directly to Florence, with positive performing Community Health feedback and her stats: “Florence has Workers delivered in the form treated 29 cases of pneumonia and her of money, new mobile phones, or patients have given her a 99% approval resources for training. rating.” DISTRICT MGR: DISTRICT MGR: Great job Florence! Your CHW, Florence You have helped 29 has helped 29 pneumonia patients pneumonia patients this year in your community 5 8 The Village Health Committee puts Florence is empowered to train together a local ceremony and provides another village member as a her with a Community Health Worker Community Health Worker to badge of excellence. This in turn builds assist her in her duties. She acts as a more trust for Community Case mentor and now both of them can Management among the villagers. handle the increasing number of cases in their village. 6 Meanwhile, the District office tracking high-performance Community Health Workers in their villages. They have a special fund set aside for incentivizing the highest performers. 32 33
  • 18. Mobile Technologies & Community Case Management Solution Highlights 1: Bridging the gap between 2: Giving voice to demand 3: Building capacity through incentives supply and health groups Instant SMS feedback collected Performance tracking enabled at SMS data collection at point of at the community and clinic levels individual and district levels transaction to increase accuracy of leading to increased demand and stock level reporting quality reporting Capturing and tracking data at point of transactions that link Community Real-time feedback to clinics, Aggregation of demand-based data Health Workers with patient outcomes Community Health Workers, village from clinics and community, enabling leaders and community on status quicker troubleshooting from Enabling 2-way communications and of actions program management ratings directly from citizens Distributed reporting of supply Real-time feedback to clinics, Real-time feedback that prompts levels and drug efficacy, allowing Community Health Workers, village motivation and behavior change for for proactive planning and local and leaders and community on status Community Health Workers national levels of actions Accelerated Community Health Reduced restock supply cycles based Faster reporting of concerns and Worker improvement and mentorship on real demand issues that might not have otherwise enablement been identified Improving community trust for Com- munity Health Workers through better alliance with Village Health Committee 34 35
  • 19. Mobile Technologies & Community Case Management Design Principles These principles emerged as a result Design for the Person Consider that Technology Changes Motivate the Private Sector of the exercises and workshop. Design for people, rather than for the Much Faster than the Health Domain Private sector partners are great, but system. Designing for people and Design for the ideal, and trust the consider their incentives to invest. Set Boundaries and Scope their everyday interactions assures technology to fill in. Technology What is there to gain in the health When choosing areas for mobile that you will uncover and solve for the changes rapidly, while the health domain or technology sector? Who technology application, focus on the right problems. sector is much more slow to change. might the big partners be? interactions that will be best enabled When designing for mobile, you have and enhanced with mobile. Setting Consider Value of Efficiencies to remember that by the time you Embrace Collaboration boundaries for the solution prevents Create communications efficiencies in design a system, features or capabili- Foster “communities of practice” or overcomplicating or overburdening and across your organization. Rather ties might have already changed in ad hoc sharing networks within UNI- the system. than forcing hierarchical, linear chains the market. CEF and its partners. Share knowl- of communications, look for overlaps edge of initiatives and pilots, what’s Apply Mobile Where Appropriate in data that can be distilled for differ- Design for Flexibility and Reciprocity working or not, build on and leverage Mobile is not a panacea—it has big ent points in the system. Design for 2-way communications. existing systems, bundle different benefits for some interactions, but in Keep in mind the need for flexibility pilots together in larger rollouts. some cases analog might actually Consider Scale from the Outset and reciprocity of communications still be best. Mobile is a tool, not the Think about creating solutions that (e.g. if you pull knowledge from a total solution. can be used elsewhere, that can grow community, you should push back with technology, that can take on information to that same community). more participants. In other words, Mobile is great at both of these. don’t design yourself into a corner 36 37
  • 20. Mobile Technologies & Community Case Management “The work you are doing gives us the opportunity to answer these important questions in real-time. Fast enough to impact how we manage our programmes, report to our donors, and have a direct effect on the lives of children.” — Nicholas Alipui, Director of UNICEF Programmes “We have taken for granted that [because the problems are complicated,] the solutions are going to be complicated. But simple things can go a long way. ” — Bernard Kasawa, UNICEF Coordinator MNCH/PMTCT Initiative Luapula Province, Zambia The principles and recommendations improve the quality of outcomes and in this report serve as guidance for 190 empower communities health workers UNICEF country offices as they inte- around the world. grate real-time monitoring and mobile technologies into their programming to 38 39
  • 21. Mobile Technologies & Community Case Management Participants Aaltje Camielle noordam Denise Gershbein Gabriele Fontana Julia Kim Merrick Schaefer Sarah Anderson Health Officer, Health Section Creative Director Health Specialist, Health Section Knowledge Management, Health Tech 4 Dev Specialist Country Technical Manager UNICEF New York frog UNICEF New York UNICEF New York UNICEF Zambia and World Bank JSI Alex Harsha Donna Espeut Garrett Mehl Julianna lindsey neal lesh Scott Ratzan Field Project Manager Deputy Director Scientist, Department of Chief Advocacy Communication, Chief Strategy Officer Vice President, Global Health Medic Mobile Concern Worldwide Reproductive Health and Research Monitoring and Analysis Dimagi Johnson and Johnson WHO UNICEF Ghana Alicia lin Fabiano Dyness Kasungami nicolas oliphant Sean Blaschke Johnson and Johnson Technical Team Leader, Child Health Heather laGarde Kajsa Westman Health Specialist, Health Section Tech4Dev Specialist Maternal and Child Health Integrated Director, Special Programs Industrial Designer UNICEF New York UNICEF Uganda Allison Green Program (MCHIP) IntraHealth frog Senior Strategist nicolas osbert Stephanie Dolan frog Eric Swedberg J F Grossen Khassoum Diallo Chief, WASH Program Manager, Malaria and Senior Director, Child Health Creative Director UNICEF WCARO UNICEF Mali Child Survival Department Alyssa Sharkey and Nutrition frog PSI Health Specialist Save the Children, USA Kumanan Rasanathan Patricia Mechael UNICEF New York Jaleen Francois Knowledge Management, Health Executive Director Texas Zamisiya Erica Kochi Marketing Manager UNICEF New York mHealth Alliance UNICEF Malawi Amy Ginsburg Tech Innovation Specialist frog PATH UNICEF New York Marc Mitchell Robert Johnston Tom Manning Jonathan Payne CEO Regional Advisor, Nutrition, WCARO Principal Designer Anirban Chatterjee Esther Ahn Partners in Health D-Tree UNICEF Western and Central Africa frog Chief of Health and Nutrition Associate Creative Director Regional Office UNICEF Ghana frog Jorge Just Mariame Sylla Troy Jacobs RapidFTR coordinator Regional Health Specialist, WCARO Robert Fabricant Child Health & Pediatric Brigitte Pedro Flavia Mpanga Kaggwa UNICEF Protection UNICEF Western and Central Africa Vice President, Creative HIV/AIDS Advisor WASH E&M Specialist ICCM Health Specialist Regional Office frog USAID UNICEF DRC UNICEF Uganda Joshua Harvey Senior Associate, Integrated Mark Young Sandhya Rao Catherine Sun Friday nwaigwe Partnerships Senior Health Specialist, Senior Advisor for Private Sector Associate Creative Director UNICEF Rwanda U.S. Fund for UNICEF Health Section Partnerships frog UNICEF New York USAID 40 41
  • 22. Mobile Technologies & Community Case Management About UnICEF About Mobile Mandate UNICEF works in 190 countries and territories to help Mobile Mandate is a collaborative platform that amplifies children survive and thrive, from early childhood through the positive social impact of mobile technologies through adolescence. The world’s largest provider of vaccines for the transformative power of design. Mobile Mandate developing countries, UNICEF supports child health leverages the skills, talents, and capabilities of frog and and nutrition, good water and sanitation, quality basic Aricent to bring about positive change in the world education for all boys and girls, and the protection of through the exploration of innovative models for service children from violence, exploitation, and AIDS. UNICEF delivery. UNICEF’s Tech4Dev organization is a signature is funded entirely by the voluntary contributions of Mobile Mandate partner on a number of programs individuals, businesses, foundations and governments. including Project Mwana, an mHealth initiative to strengthen health services for mothers and infants in East www.unicef.org Africa. Other Mobile Mandate programs include Project Masiluleke, an mHealth initiative to battle AIDS in South Africa; Movirtu, a phone-sharing system in Kenya; as About frog well as Mobile Money Afghanistan, a research project that investigates the use of mobile phones for noninstitutional frog works with the world’s leading companies, helping banking in Afghanistan. them to design, engineer, and bring to market meaningful products and services. With an interdisciplinary team mobilemandate.frogdesign.com of more than 1,600 designers, strategists, and software engineers, frog delivers connected experiences that span multiple technologies, platforms, and media. Clients include Disney, GE, HP, Intel, Microsoft, MTV, Qualcomm, Siemens, and many other Fortune 500 brands. Founded in 1969, frog is headquartered in San Francisco, with locations in Amsterdam, Austin, Boston, Chennai, Bangalore, Gurgaon, Johannesburg, Kiev, Milan, Munich, New York, Seattle, Shanghai, and Vinnitsa. frog is a company of the Aricent Group, a global innovation and technology services firm. www.frogdesign.com 42