1. Reaching Beyond the Grid: K4Health
Malawi Demonstration Project
CORE Group Presentation by Liz McLean, MSH
May 2012

2. K4Health Malawi
Challenge
How can we support Community Based Distribution
Agents to deliver effective FP/RH services at the
community level though they are in remote
locations, receive limited training and have limited
access to resources available at the district and
national level?

3. K4Health Malawi
SMS Goal
Goal:
Increase CHW’s access to FP/RH
information through mobile telephone
networking using FrontlineSMS in
Salima and Nkohtakota Districts
Desired Result:
Timely and accurate Family Planning
and Reproductive Health services
provided to men and women in hard
to reach areas, reducing incidences of
maternal and neonatal mortality

4. K4Health Malawi
Key Interventions
 Formation of a national Knowledge Management
Taskforce to manage and disseminate technical
information on FP/RH and HIV/AIDS.
 Establishment of two District Learning Centers (DLCs) at
hospitals in Nkhotakota and Salima to support information
flows from and to the national, district, and community
levels.
 Creation of an SMS-based mobile phone network to
improve communication and information sharing among
community health workers.

5. K4Health Malawi
Project Timeline and M&E Tools
LDP for KM Final LDP
Launch (Feb) Workshop Formal
Dissemination Mid Term (Dec) Capacity Some project
Workshop & KM Toolkit Survey (Nov)
Taskforce Building to funding ends
Development MOH
established (April) (June )
(December) (April)
LDP Coaching
2009 2010 2011
Support to
mHealth End Line MOH
Needs Baseline mHealth RH Toolkits
Scale up (400 Assessment & sustained
Assessment Net launch published
additional Net Mapping (July-Dec)
(June-Sept) Mapping (June) (Aug)
phones) (Feb) (2) (May)
(March)

6. K4Health Malawi
Design of the mHealth project
Resources: $25 mobile phones and $7 solar
chargers for 663 CHWs
Partnership: Medic Mobile (FrontlineSMS);
MOH; BASICS; and other SMS projects
SMS system:
• SMS alert system (i.e. notification of
community vaccination dates, trainings,
etc)
• Peer-to-peer SMS network (ongoing
support for CHWs)
• On-demand automated FP/RH info and
tips (immediate info on dosages or other
automated responses to FAQ)

7. K4Health Malawi
mHealth Project
Step 1: Client/CHW
has a question
In a remote area, a Community Health
Worker (CHW) or client has a question.
Step 5: CHW takes action
The CHW can now make a more
informed decision and provide case
specific guidance to clients.
Step 2: CHW sends
Step 4: CHW receives SMS System question via SMS
answer via SMS Average time required to The CHW sends a SMS to
The CHW receives an answer to their contact and receive feedback the HUB at district hospital,
question via SMS from HUB, District from the person providing using a direct line or key
Coordinator, or another CHW. technical support: word messaging, or to
other CHWs in district.
9 minutes
HUB Step 3: District responds
District Coordinators/Supervisors receive
the SMS message and respond at the
HUB, from their personal phones if key
word messaging was used, or another
CHW responds directly.

8. K4Health Malawi
Results
• Faster feedback from supervisors; with the
phones the average time to receive feedback
was 9 minutes as opposed to over 1 day
• Improved reporting and communication as
the CHWs were able to submit reports over
their phones and talk with their supervisors
immediately
• Cheaper access to information as SMS only
cost 11 Kwacha (MK) whereas the same
information would have cost 464 MK if the
CHW needed public transportation to
discuss with a technical expert
• More reliable clinical information as CHWs
could connect directly with technical experts
at the District Hospitals

9. K4Health Malawi
Results
• Increased CHW self-confidence and client trust
as the CHWs were able to quickly secure the
technical information they needed
• Improved detection and prevention of stock-
outs as the SMS allowed for constant updating
• More efficient referrals as CHWs could check to
see if a service was available before referring a
patient
• Widened service coverage as the CHWs were
able to provide faster services, allowing them
more time to reach new clients
• Prompt responses to outbreaks; the average
time went from 523 minutes to 3 minutes

10. K4Health Malawi
June 2011 National Level Map
HIV Testing Information
Family Planning Information

11. K4Health Malawi
Why Net-Mapping to support our M&E?
 Satisfies both research interest and immediate project
management needs
 Is low-tech, low-cost, intuitive, and inter-culturally
applicable
 Makes implicit knowledge explicit
 Is flexible for use in different contexts
 By visualizing the network in which we were working, we
could analyze, improve, and influence that network

12. K4Health Malawi
What is Net-Mapping and how does it work?
It’s a 5 step process:
Step 1: Identify a core question: Who
influences X in a certain context?
Step 2: Name stakeholders: Ask participants
to identify all the stakeholders involved in
their network.
Step 3: Generate the links: Ask them to draw
lines to reflect the relationships they have with
one another.
Step 4: Determine influence: How influential
is each actor?
Step 5: Discuss and validate with participants

13. K4Health Malawi
Core Question: What are the critical information flows for Malawi in
improving healthcare for HIV/AIDS and Reproductive Health?
Links:
- Who provides technical information on HIV testing?
- Who provides technical information on family planning?

14. K4Health Malawi
Before and After Map Comparisons at District Level
Salima District Map in 2010

15. K4Health Malawi
Before and After Map Comparisons at District Level
Salima District Map in 2011

16. K4Health Malawi
Evaluation Activities: Social Network Analysis
Salima 2011 mobile phone impact
on communication

17. K4Health Malawi
Evaluation Activities: Social Network Analysis
‘’At first it was taking us
Salima 2011 mobile phone impact weeks without having the
on communication supplies whenever we
had stock outs, but with
the coming in of this
project we are able to get
all the supplies that we
want in time, because
now it’s just a matter of
sending an SMS to the
supervisor.”
CBDA in Nkhotakota

18. Questions ?