This document discusses how developing mHealth (mobile health) systems can help improve quality of healthcare, especially in low and middle income countries. It describes D-tree International's work developing decision support tools for frontline health workers using mobile phones. An example from Malawi helped community health workers better identify and treat childhood illnesses like pneumonia through a guided mobile app for assessments, referrals, stock management and reporting. Lessons learned stressed the importance of involving local stakeholders, adapting to existing systems, and ensuring technology supports - rather than drives - health programs.

1. Developing mHealth Systems to
improve quality of care
Steve Ollis
D-tree International
sollis@d-tree.org
www.d-tree.org
@DtreeInt

2. Mobile Trends
Mobile phone
penetration has
drastically increased
over the last decade
especially in
developing countries.

3. Global Health Challenges
Shortage of almost 4.3 million doctors, midwives,
nurses and support workers worldwide, especially
in low and middle income countries.
Obstacles to Good Healthcare
- Limited number of healthcare providers
- Heavy client load
- Limited training
- High burden of disease
- Limited financial resources
- Paperwork

4. • Provide decision support tools for use by
frontline health workers
– Design, Test and Deploy systems
– Partner with MOH and other health NGOs
• Focus areas:
– Maternal and Child Health
– Chronic Disease
What D-tree does

5. Types of mHealth interventions
mHealth systems not apps!

6. CCM Malawi

7. The challenge
• HSAs do not always follow guidelines
– 56% asked about 3 danger signs
– 37% assessed for 4 physical danger signs
– 57% provided correct referrals and pre-referral
treatment
– Major gap in identification of fast breathing
• Stock management
• Data flows for monthly reporting

8. CCM in Malawi
• Phase 1 – cIMCI tool on Nokia phones
• Phase 2 – integrated CCM on Android
• Vaccinations
• Commodity tracking/reporting
• Monthly reports
• Dashboard
• Supervisory application
• Phase 2a – modification to allow for mRDTs
• Phase 3 – integration with CBMNH

9. Patient history
HSA can review patient history

10. Sick child form
HSA guided through sick child protocol

11. Counting breaths
Uses phone for time measurement
Absence of such measuring device had been major reason for referral

12. Outcome of assessment
Referral Home Treatment

13. Vaccinations

14. C-stock Integration
HSA reminded when monthly stock report is due
Entering new stock levels

15. Web Dashboard

16. Lessons learned
• Fast pace of technological change
• Change Management essential
• Encourage data driven management
• Field refinement is critical
• Users must feel application supports them
• Don’t let technology push the program
– Sometimes a phone is just a phone – and that’s great!

17. Recommendations
• Involvement with mHealth working
group in each country
• Look for existing projects to leverage
• Adapt each project around the in-country
m/eHealth ecosystem
• Partner with MOH and consider the entire health
system
• Plan for integration with HMIS from the start
• Leverage mFinance, mAgriculture, other
e/mDevelopment initiatives

18. What’s next
• Improved integration of facility and
community
• Integration of across domains
• Improved dashboard analytics
• Continued usage of mobile money
• Exploration of integration with point of care
diagnostics / unique identifiers

19. Thank you!
For more information:
Steve Ollis
sollis@d-tree.org
www.d-tree.org
@DtreeInt