The original abstract was published on USAID’s mHealth Compendium, Fifth Edition. To read the full report, click here.

Photo: Print screen of USAID's mHealth Compendium, Fifth Edition
Photo: Print screen of USAID’s mHealth Compendium, Fifth Edition

Severe shortages of qualified health workers and poor communication and coordination among those on the front lines have exacerbated the Ebola virus disease (EVD) outbreak in West Africa.These challenges were hindering the delivery of quality health services in the region even before the outbreak. Harnessing mobile technology and using it to improve existing health information systems (HIS) makes it possible to rapidly strengthen communication among health authorities, the health workforce, and local communities, in order to save lives.

In August 2014, the mHero Partnership, led by IntraHealth International, the US Agency for International Development (USAID), UN Children’s Fund (UNICEF), and a team of international stakeholders, created mHero.

The mHero platform allows health workers, government authorities, and other key stakeholders to engage in real-time, targeted communication via two-way short message service (SMS), interactive voice response, and direct calls. mHero communications, which are flexible and scalable, and can be triggered both centrally and locally, go far beyond the traditional “message blasts” offered by many technology vendors, enabling stakeholders to rapidly respond to health workers’ needs.

About mHero

mHero unites globally recognized technologies—RapidPro, the iHRIS open source health workforce information system, andDistrictHealthInformationSoftware(DHIS2)—using Open Health Information Exchange interoperability architecture. Drawing on information about health workers and facilities in iHRIS and DHIS2 and harnessing RapidPro’s platform, mHero permits communication via basic mobile phone. Through country ownership, open technologies/standards, and a collaborative partnership,
the mHero approach exemplifies the nine principles for digital development. The platform also allows for continual development of extra modules and features for Ebola-related services and those for maternal, neonatal, and child health.

Since 2014, mHero has operated at pilot scale in Liberia, where a Ministry of Health and Social Welfare (MOHSW)- appointed team designed, deployed, and guided the country’s approach. With help from Liberia’s mobile network operators, the team set up easy-to-remember phone numbers (short codes) for free SMSs and calls within mHero’s network. The health ministry provided direction to configure high-priority use cases and readied them for launch within weeks. Priority messages included: verifying active health workers; identifying inactive workers to re-engage them and restore essential services; and determining health facility status through SMS exchange with officers-in-charge. Full mHero rollout in Liberia is scheduled for mid-2015. Implementation is also being initiated in Guinea and the health ministries in Sierra Leone and Senegal have expressed interest. The platform can be used to quickly disseminate critical information; rapidly collect data on key health services delivery indicators and health workforce management areas; support continuing professional development; identify and monitor health worker attitudes and needs related to the work environment; and provide a technical resource for frontline health workers.

Evaluation and Results

The Liberia pilot marked mHero’s launch and tested its technical capabilities. At the outset, the mHero team and ministry leaders discussed post-Ebola sustainability, county- level decentralization, and integration of mHero activities with existing systems. Working with technology experts from UNICEF and IntraHealth, the MOHSW adapted, tested, and enhanced the platform. The initial stages of the Ebola crisis greatly disrupted Liberia’s health workforce, with some health workers moving to community care centers and Ebola treatment units and others abandoning their posts due to fear or uncertainty. It became clear that existing data in iHRIS needed validation to ensure accurate personnel records for planning, management, and communication. mHero’s staff validation use case enabled the MOHSW to update iHRIS records in real time, including verifying critical health worker contact information.

During the pilot, mHero sent SMSs to 482 health workers in four counties (Bomi, Grand Cape Mount, Grand Gedeh, and Margibi) to validate health workers’ phone numbers, location, job title, supervisor, and facility. In addition, this use case sought to provide information about the proportion of health workers submitting bank account information (critical for timely payments) and use of facility attendance logs. At the time, only 60 percent (n=289) of the 482 health workers were reached due to ongoing negotiation of mobile network operator contracts. Promisingly, of the 289 health workers reached, 57 percent (n=165) responded to the first mHero message. About three-fourths (72 percent or n=119) of those who responded to the first message completed all 15 questions in the workflow. Most (92 percent) were frontline health workers; the rest were administrative and support staff. Nearly all 119 respondents confirmed that the name in iHRIS was correct (95 percent), reported submitting account information to their human resources officer (90 percent), and reported completing daily attendance sheets at their health facility (97 percent).

Lessons Learned

  • Health workers were receptive to the mHero messages, wanting to share information and actively participate in the system.
  • Several different planning, implementation, and monitoring tools created by the MOHSW contributed to mHero’s strong, efficient, and effective operations. These tools continue to be adapted and updated.
  • The initial mHero use case increased the MOHSW’s understanding of the value of effective and efficient communication with health workers, as they had not had access to such a rapid communication method prior to mHero.
  • The pilot experience provided important lessons for enhancing the mHero approach on a global level, particularly with regard to the engagement strategy, tools, and technologies.

Conclusion

IntraHealth and UNICEF continue to engage with global partners to harness the interoperability of mHero with HIS and further develop the software. mHero implementation will continue in West Africa and beyond to strengthen communication between health ministries and health workers. In Liberia, the mHero team is scaling up mHero in line with MOHSW priorities. Crucial next steps include: planning mHero sustainability beyond the Ebola response; rolling out mHero with administrators at the county level; expanding monitoring and evaluation efforts; and establishing a strong governance system within the ministry to ensure effective and efficient implementation of mHero. In Guinea, initial mHero use cases will be developed to support health workers providing maternal,newborn,and child health care.

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Geographic Coverage: West Africa
Implementation Partners: IntraHealth International, UNICEF, Jembi Health Systems,Thoughtworks, HISP, mPowering Frontline Health Workers
Donors: UNICEF, USAID, Johnson & Johnson

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