Early sketches of continuum model

One of the projects I’ve been working on with the Tech Innovation Unit is in defining and communicating their vision for scaling mHealth projects (healthcare supported by mobile devices). Over the last number of years, UNICEF and their partners have seen how mobile technologies can be used to overcome a wide variety of bottlenecks in healthcare systems. UNICEF have already implemented a large number of such projects across a wide range of countries.

In moving mHealth forward globally, there are a number of key areas that UNICEF is strategically focussed on:

  • Scaling existing initiatives (both inside and beyond existing countries),
  • Expanding mHealth to a wider range of healthcare applications,
  • Prioritizing interoperability with other systems and tools.

Community Health Workers = Linchpin

In understanding UNICEF’s mHealth work, it’s important to introduce the Community Health Worker (CHW): a volunteer member of a community who is often the main link to the formal health system. Increasingly, CHWs are also trained to diagnose, treat and refer common childhood illnesses. Recent studies have shown how vital CHWs are to healthcare for the poorest and most marginalized. They have become the linchpin in many health systems that are spread over large rural areas, particularly where there is a critical shortage of health professionals and limited access to clinics and other facilities. From the outset, UNICEF made a strategic decision to focus a number of their mHealth initiatives around CHWs; initiatives that have proven to be incredibly valuable in supporting these essential volunteers.

Mobile Technologies and Community Case Management

Mobile Technologies and Community Case Management
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When I joined the team, the work built on a number of existing implementations as well as a growing body of research. In particular, the outcomes of a 2011 workshop have had a large influence. UNICEF and frog design brought together public health, mobile health and design experts to create a model for how mobile can best support CHWs. (The document they developed is freely available and is an excellent insight into the role mobile can play in these environments.)

Mwana in Zambia/Malawi and ANC in Rwanda

I’ll briefly mention two mHealth initiatives which support the work of CHWs. Both are built on RapidSMS, an open-source SMS-based system that UNICEF has been involved in creating.

The Mwana Initiative delivers early infant diagnosis (HIV) results to rural and under-served communities in Zambia and Malawi via text messages rather than paper. It has improved test result turn-around time back to care givers by over 50%. Community Health Workers also register births and trace patients via SMS to ensure that they receive key childhood interventions.

In Rwanda, a similar system has been deployed nation-wide to improve antenatal and neonatal service delivery at the village level. The system helps community health workers track pregnancies, report on danger signs during pregnancy, subscribe to emergency alerts to ensure that women can access emergency obstetric care, and provides a real-time national surveillance mechanism for maternal health.

Although these projects use a common code framework, capture overlapping data and involve a common way of working for the user, they are very much standalone systems. The vision is that multiple mHealth tools like these could be integrated, working together in a bespoke system depending on the needs of a particular country or region. But with many diverse stakeholders involved (technical, policy-level and health experts from disparate fields), how can this vision be shared and pursued without getting bogged down in complex details and differing approaches?

A shared model is needed; a map of the common landscape where everyone is working.

The Continuum of Care

Much of UNICEF’s work focuses on the health and well-being of children and their mothers. Pregnancy, birth and infancy are a particular focus; a child is about 500 times more likely to die in the first day of life than at one month of age. Improving the health and nutrition of mothers-to-be and providing quality health services are pivotal to addressing many underlying causes of child mortality. Across UNICEF’s focus areas (nutrition, HIV/AIDS, health, etc.), the continuum of care is a common model for mapping out the stages of this vulnerable time in the lives of a mother and child, and a useful model for mapping the interventions that can be made at key points.

Leveraging Mobile Technology along the Continuum of Care
Leveraging Mobile Technology along the Continuum of Care

The continuum is an excellent model (because it’s a conceptual framework shared by many) to think about how mHealth solutions might work together as part of an integrated system. A number of UNICEF’s existing mHealth initiatives already take place at different points along this continuum (See the mappings of Mwana and Rwanda ANC below).

Mwana mapped on the Continuum of Care
Project Mwana mapped on the Continuum of Care
Rwanda's  mHealth ANC mapped on the Continuum of Care
Rwanda’s mHealth ANC mapped on the Continuum of Care

In addition to this is data being shared across various mHealth solutions, it is also available to provide realtime monitoring data for governments and agencies.

Realtime Data Flow in an mHealth System
Realtime Data Flow in an mHealth System

The power of visual communication

For me, as a designer, this project has been an exciting opportunity for me to come alongside experts in the field as they define their vision moving forward, providing visual systems and frameworks to not just communicate these strategies, but to use as tools for discussion, refinement and shared understanding.

In a recent meeting with frog design and a number of key mHealth stakeholders, it was compelling to see how these simple visual tools were identified with by each party, even though they approached topics from very different directions, and at times used different language. The visual frameworks we developed were used as a common ‘map’ of the landscape which they everybody shared. Together, this map could be adjusted and refined.

As further versions are developed and refined with the team at frog design, they will provide a useful common ground for a further workshop in Washington D.C. August 2012 with a wider audience to develop strategies for the use of mobile technology in the effort to prevent mother-to-child transmission of HIV.

A landscape of solutions

As always with technology, there is no one-size-fits-all solution. Problems, resources and cultures differ; a solution that works in one place, may not work in the next. But shared successes and failures, and open-source adaptable systems can be incredibly helpful as governments and agencies seek to implement mHealth projects.

As this landscape of shared customized solutions grows, interoperability will be key. As various solutions are applied along the continuum of care (and beyond), they need to be able to work together, share patient records and make data available for unified reporting.

The vision for scaling mHealth
The vision for scaling mHealth

With this in mind, UNICEF are hosting a technical software design workshop in Rwanda July 2012 with key stakeholders in the mHealth and technology for development arenas. The key objective of this workshop will be to advance the development of an mHealth software suite for maternal, newborn and child health, nutrition and Elimination of Mother-to-Child Transmission of HIV (eMTCT). The outcome will be a common technical roadmap to improve the interoperability of key existing open-source platforms already being implemented in target countries. I am looking forward to taking part, and exploring how we can leverage design thinking and visual communication to support the outcomes of this workshop.

In the long run, I’m excited by how this work can feed into open-source tools, approaches and frameworks available for any agency, government or community looking to implement mHealth solutions. Even though mHealth initiatives have proven themselves in a variety of settings, implementing them successfully is another thing. Hopefully, these shared tools, lessons learnt and examples (as well as a common model for discussing them) will resource many moving forward, and ultimately to contribute to a reduction in child mortality.

This post was written by John Ryan, the 2012 DesignMatters fellow from Art Center College of Design with UNICEF’s Tech Innovation Unit in New York.

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