With a worldwide penetration rate of over 85%, the mobile phone has become one of the most transformative tools in human history. As mobile communication technologies become less expensive, faster, and more accessible, the ability of people, communities and institutions to share information and knowledge will continue to skyrocket. Specifically for Global Health, the use of mobile communication and network technologies for delivery of health care (mHealth) holds great promise for the future. In low resource settings, community health workers (CHWs) provide a backbone for the delivery of health care services. Often isolated and without significant formal education or training, CHWs can be seen as key connectors between their communities and the formal health care system. In the hands of CHWs, mHealth tools may facilitate effective task shifting; by expanding the pool of human resources, increasing the productivity of health systems, and lowering the cost of services. The reported experience with mHealth suggest a wide range of opportunities exist to improve ease, speed, completeness and accuracy of the work of CHWs. The outcomes associated with these sort of new capabilities can be expected to result in ongoing improvements in performance on key national health indicators. The presentation will examine the state of the art and science-- by describing a systematic review of the literature and citing examples in action -- and provide recommendations focused on the design and development of mHealth tools for use by CHWs to strengthen Global Health interventions. Speaker Bio: Dennis M. Israelski, M.D www.instedd.org/team

1. Enhancing Community Health Dennis M. Israelski, MD
President and CEO, InSTEDD
Workers Performance With
Mobile Technology
Innovative Support to from PEPfAR
with support Emergencies
Diseases and Disasters

2. Source: Wall Street, 20th Century Fox, Written by Stanley Weiser and Oliver Stone, Directed by Oliver Stone, Produced by Edward Pressman, 1987

3. source: Motorola, 1973

4. 4b
Mobile phone subscriptions (billions)
developing countries
developed countries*
3b
2b
1b
2000 ‘01 ’02 ’03 ’04 ’05 ’06 ’07 ’08
source: World Bank, 2011 http://data.worldbank.org/indicator/IT.CEL.SETS.P2 *OECD members

5. Global Cell Phone Usage
Cell Phones Per Person
Over 1.20 .901 - 1.20 .601 - .900 .301 - 600 Under .300
source: World Bank, 2011 http://data.worldbank.org/indicator/IT.CEL.SETS.P2

6. 87% of the global population is a mobile phone user
Cell Phones Per Person
Over 1.20 .901 - 1.20 .601 - .900 .301 - 600 Under .300
source: World Bank, 2011 http://data.worldbank.org/indicator/IT.CEL.SETS.P2

7. 87% of the global population is a mobile phone user
4.5 billion
source: CIA World Fact book 20010-11
users in the developing world

8. A kid in Africa with a
smartphone today has
access to more information
than the President of the
United States had just
15 years ago.
Ray Kurswell
quote: kid in
africa has more
info than the pres
15 yrs ago
source: Quote from Futurist, Ray Kurzweil, Time Magazine, March 26, 2012

10. “ This device has become part of the fabric of
society, whether a teenage girl taking a Blackberry
to bed with her, or a farmer in an African village
trying to find out the latest crop prices.
”
source: Quote from Ben Wood, mobile phone analysis at CCS Insight, 2010, http://www.bbc.co.uk/news/10569081

11. “
The mobile phone
just may be the
most prolific
consumer device
”
on the planet.
source: Quote from Ben Wood, mobile phone analysis at CCS Insight, 2010, http://www.bbc.co.uk/news/10569081

12. <30 years

13. <20 years
source: Nokia, 2007

14. small
lightweight
portable
connected
inexpensive
simple
convenient
intuitive
+ accessible
opportunity

16. 57
countries have
severe shortages
of health workers

17. 36
are in sub-
Saharan Africa

18. Countries with a Critical Shortage of Health Service Providers
(doctors, nurses and midwives)
countries with critical shortage countries without critical shortage
source: WHO, Global Atlas of Health Workforce (http://www.who.int/mediacentre/events/2006/g8summit/healthworkers_large.gif)

19. 53% of the population of Africa
owns a mobile phone
source: World Bank, 2011

20. 53% 74% of the population of Asia
owns a mobile phone
of the population of Africa
owns a mobile phone
source: World Bank, 2011

21. mHealth:
at the intersection of mobile communication
technologies and health
+ health issues
mobile + service delivery
communications mHealth + decision support
technologies + supervision
+ more
source: USAID Community Health Worker Evidence Summit Concept Note, 2012

22. The Community Health Worker
at the Intersection of Two Dynamic Systems
graphic: Mobile Tech and Community Case Management , UNICEF & frog design

23. mHealth:
the delivery of health care services
via mobile communication devices

24. Systematic Review of the Literature
initial search strategy
n = 5,868
duplicate citations
identified & excluded
n = 1,201
unique citations
n = 4,667
mHealth exclusions based on title,
abstract & author key words
relevant mHealth
n = 2,064
literature obtained
n = 2,603
CHW exclusions based on title,
abstract & key words
relevant CHW & mHealth
n = 2,031
literature obtained
n = 35
CHW & mHealth inclusions
based on citations
full text of potentially n=4
relevant literature obtained
n = 37
studies excused
post full-text review
literature included in n = 11
analysis
n = 26
Catalani, C et. al. ( Manuscript Submitted)
supported by HIPPP, PEPfAR

25. medical engineering
mHealth
research areas
global
public
development
health
databases
Catalani, C et. al.

26. Systematic Review of the Literature
Catalani, C et. al. ( Manuscript Submitted)
supported by HIPPP, PEPfAR

27. Systematic Review of the Literature
Catalani, C et. al. ( Manuscript Submitted)
supported by HIPPP, PEPfAR

28. - errors
- data loss
- lack of real-time QA
- lack of CHW supervision
- lack of rapid response
- travel expenses

29. africa asia
n=9 n=5
mHealth
research locations
south north
america america
n=2 n=1
Catalani, C et. al.

30. provide
address
decentralized
health issues
services
mHealth
research use cases
provision of professional
medical support &
services supervision
Catalani, C et. al.

31. Colombia | multimedia mHealth technologies
A simulated experimental study in + significantly decreased errors
Colombia used mobile multimedia + increased compliance with care protocols
devices to facilitate point-of-care + combination of text, audio, images and
video improve patient care
clinical decisions among CHW.
Florez-Arango JF, Iyengar MS, Dunn K, Zhang J. Performance factors of mobile rich media job aids for community
health workers. Journal of the American Medical Informatics Association : JAMIA. 2011 Mar 1;18(2):131-7.

32. Tanzania | CommCare maternal mHealth technologies
CommCare is a CHW focused automated + improved time management
quality improvement system operating + improved data reporting
through mobile phones. + helpful decision support
Svoronos T, Mjungu D, Dhadialla P, Luk R, Zue C. CommCare : Automated Quality Improvement To Strengthen
Community-Based Health The Need for Quality Improvement for CHWs. New York City: 2010.

33. + health
+ human
system
resources
productivity
mHealth
effective support for
task shifting
- costs - errors
Catalani, C et. al.

34. + fewer errors
+ less data loss
+ real-time review of quality
+ close CHW supervision
+ rapid response capabilities
+ cost effective

35. mHealth technologies
Verboice is a
customizable
application that
empowers users to
build their own
interactive voice
response systems.

36. mHealth technologies
Baby Monitor is an
unconventional approach
to service delivery along
the birth continuum in
remote locations by
creating an interactive
voice response
application for mobile
phones that is designed
for mothers as
end-users.

37. mHealth technologies
Reporting Wheel is a
non-electric device that
simplified data reporting for
the most remote workers,
including the illiterate.

38. mHealth technologies
Resource Mapping helps
people to collaboratively
track their work,
resources and results
geographically and
through SMS.

39. mHealth technologies
GeoChat is enables self-
organizing group
communications by allowing
users to link the field,
headquarters, and the local
community in a real-time,
interactive conversation
visualized on the surface of a
map. GeoChat is a tool for
group communications based
on SMS, email, and Twitter.

40. mHealth technologies
GeoChat is a flexible open
source group
communications technology
that lets team members
interact to maintain shared
geospatial awareness of who
is doing what where — over
any device, on any platform,
over any network.

41. mHealth technologies
Nuntium is a set of
services and clients that
allow anyone to build
SMS-based applications
with uses that range from
simple modem-based
needs to countrywide
deployments integrated
with wireless operators.

42. mHealth technologies
Nuntium is used every
day in mission-critical
applications including
ministries of health or in
crises such as in Haiti.

43. Research & Evaluation

44. project
project A project
H B
small scale
project independent project
exploratory
G non-collaborative
C
project project
F project D
E

45. project
project A project
H B
PILOTITIS
small scale
project independent project
exploratory
G non-collaborative
C
project project
F project D
E

47. project
project A project
H B
interoperability
project reusability project
scalability
G sustainability
C
project project
F project D
E

48. Recommendations for the Future
+ country leadership & ownership*
+ human-centered design
+ engaged end users
+ capacity development*
+ strategic reuse*
+ interoperability
+ open source accessibility*
+ coordinating, harmonizing & sharing*
+ research & evaluation*
+ implementation science agenda for M&E,
operations research, economic assessment
& impact evaluation
*Greentree Principles

49. Innovative Support to Emergencies
Diseases and Disasters
www.instedd.org

50. Enhancing Community Health
Workers Performance With
Mobile Technology
Innovative Support to Emergencies
Diseases and Disasters
(manuscript in preparation)

51. Health Informatics Public Private Partnership
Management Team
Paul Biondich, Regenstrief Institute Mike Gehron, OGAC
Dennis Israelski, InSTEDD John Novak, USAID
Chris Seebregts, Jembi, South Africa Xen Santas, CDC
Chris Bailey, WHO*
A Central OGAC Initiative
*former member

52. 1. Narasimhan V, Brown H, Pablos-Mendez A, et al. Responding to the global
Enhancing Community Health
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