Programme Mwana:A Zambian mHealth Initiative

Programme Mwana• Piloted in Zambia by MoH with support from UNICEF, ZCAHRD, CHAI & ZPCT II

• Addresses Early Infant Diagnosis of HIV and post-natal follow-up and care

Programme Mwana• Piloted in 31 clinics across 13 districts in 6 provinces for over a year, delivering thousands of results

• Scale-up approach pre-tested in 30 facilities in Kalomo District in Southern Province

• Built on RapidSMS, an open source framework

• Designed to be as a MoH owned and operated enterprise mHealth platform

Locations of Pilot SitesLuapula Province:• 11 Sites• Across 3 Districts• Implementer: UNICEF

Southern Province:• 10 sites• Across 2 Districts• Implementer: BU

Central Province:• 3 Site• Across 3 Districts• Implementer: CHAI & ZPCTII

Copperbelt Province:• 3 Sites• Across 2 Districts• Implementer: CHAI & ZPCT II

Northern Province:• 2 Sites• Across 1 District• Implementer: CHAI & ZPCT II

North-Western Province:• 2 Sites• Across 2 Districts• Implementer: CHAI & ZPCT II

Programme Mwana• There is an mHealth Technical Working Group that coordinates Programme Mwana activities and other mHealth initiatives

• The TWG is holds meetings every month and has sub committees that look address the day to day activities

• The TWG is chaired by MoH

Locations of PCR LabsProvinces the Labs Serve:• Arthur Davison

• Northern• Northwestern• Copperbelt• Luapula• Central

• UTH• UTH facility• Southern

• Kalingalinga• Lusaka• Eastern• Western

Early Infant Diagnosis Results Cycle

ref - Early Infant Diagnosis: System Summary (2008) – MoH & Clinton H/A Initiative

National average of 2008 including rural and urban

Programme Questions

• Can we use mobile technology to significantly speed up getting infants HIV results to their caregivers?

• Can we use mobile technology to increase post-natal visits of mothers to health facilities?

• Delivers infant HIV results from Lab to Facilities via SMS and SMS Printers

• Tracks samples through the logistics system

• Provides government monitoring tools

HUB

From:Results160

Hello Maria, there are 3 DBS results for your clinic.

Please reply with your PIN to retrievethese results

When results are ready the central SMS System sends a message alerting the clinic workers results are ready.

Workflow: Phone: Results Retrieval 1

Kanyihampa Clinic.

Patient ID: XXXXXX-0001-1.

HIV-DNAPCR Result:NotDetected.

Approved by ADH DNA-PCR LAB.

When a result is ready it is sent by SMS to the printer at the facility it the sample was collected at.

Workflow: Printer: Results Retrieval 1

• Patient tracing by Community Health Workers

• SMS Reminders for post-natal visits

• Specific traces for DBS results being returned

Quantitative: Pre-SMS System v Post-SMS System

On average results were

56% faster

between sample collection and delivery to caregiver

Quantitative: Pre-SMS System v Post-SMS System

Pre-SMS Post-SMS0

5

10

15

20

25

30

35

40

45

50

45.5

21

Aggregated Turnaround Time to Facility, Pre- vs. Post-SMS system, Central, Copperbelt, Northern, North-western Provinces

Pre-SMS and Post-SMS

Turn

arou

nd T

ime

(day

s)

Quantitative: Hardcopy v SMS Results

While urban facilities saw only a 5% improvement rural facilities received results

46% faster

between sample collection and delivery facility using SMS

Quantitative: Hardcopy v SMS ResultsLuapula Province

SMS (N=146) Hard Copy (N=103)0

10

20

30

40

50

60

70

60

42

SMS vs. Hard Copy, Volume of Results Received, Luapula Province

Method of Result Receipt

Perc

ent

Quantitative: Hardcopy v SMS Results

On average

30% more

results arrived by SMS than by hardcopy

Triangle of Management

Health Facility

Lab Team

Software Development Team

Secondary Support

Primary Support

Aggregated Web Reports

Real-time Alerts

Way Forward

• Scaling Up the system nationally with the help of partners• Each year we set scale up targets• This year we have a target of 300 sites. We are on course to meet this target. •To date we have scaled up Programme Mwana to over 462 sites.

Way Forward

• Scaling the system nationally between now and 2015

• To date we have scaled up Programme Mwana to over 400 sites.

Thank You