Reproductive Health | TechChange | The Institute for Technology and Social Change

On this year’s International Women’s Day, we recognize the important work our alumni and partners are doing to empower women and girls across the world.

At TechChange, there are few areas we see this empowerment happening than in the field of family planning and reproductive health. As we’ve seen in our mHealth online course and community, many organizations are doing fantastic work in this area including the UN Foundation and MAMA, D-Tree International, FHI 360, Jhpiego, John Snow Inc., and more.

We’re hoping to further explore the issue of gender in global development programs and technology in our upcoming online course on Gender.

Use the coupon code, IWD2015, by this Friday, March 13, to get $50 off any TechChange open online course such as mHealth, Mobiles for International Development, Gender, and more.

GIZ Nepal participants Pushpa Pandey, Valerie Alvarez, and top TechChange student Bikesh Bajracharya with TechChange Communications Associate Samita Thapa, (and TechChange cubebots).

In our most recent mHealth online course, twelve participants from GIZ (Deutsche Gesellschaft für Internationale Zusammenarbeit) Nepal enrolled in the course to support its mHealth pilot for adolescent sexual and reproductive health. This holiday season, I was fortunate enough to return to my native home of Nepal to meet these TechChange alumni in person at the Nepali-German Health Sector Support Programme (HSSP) at their new office in Sanepa, Nepal. Since the September 2014 mHealth pilot launch, more than 150,000 adolescents have used their interactive service.

Nepal’s National Health Education, Information and Communication Center (NHEICC) developed a National Adolescent Sexual and Reproductive Health Communication Strategy (2011 – 2015) that stressed strongly the use of modern methods of communication in its implementation. GIZ, Health for Life (H4L), and the UN Population Fund partnered under NHEICC’s leadership to initiate this SMS based mHealth project – the first in Nepal. The SMS messages and interactive package focus on delaying marriage and pregnancy, healthy timing and spacing of babies, health and hygiene, and addressing gender based violence. The local mobile services provider, Nepal Telecom and NCELL, distributed the interactive SMS package that includes an encyclopedia, role model stories, quizzes, and a hotline for further questions.

Mr Khaga Raj Adhikari, Minister, Ministry of Health and Population launching ‘m4ASRH’ (Mobile for Adolescent Sexual & Reproductive Health) on 18 September 2014.

Since Pushpa had shared the status of the GIZ mHealth pilot in Nepal as her final project for the mHealth online course the day before we met, it was especially great to catch up with her in person! She expressed that this mHealth course was much more engaging and fun to complete than other online courses she has tried out. Bikesh, the top user in our course with over 400 tech points, is new to the GIZ team and very excited to apply what he has learned in the mHealth course to his work in Nepal. Valerie recently arrived in Nepal and very new to the GIZ-team, was also excited to learn how much the other participants were engaging and that she can still access all course material for four more months.

All three GIZ Nepal participants shared their astonishment on how many tech points Bikesh was able to stack up in the course and also the fantastic course facilitation by Kendra. They also admitted that hearing Pushpa present in the mHealth course gave them insights that they weren’t aware of even though they work at the same office. While taking a technological approach to development projects in a country like Nepal can be challenging, it is an even bigger challenge to get the government’s buy in. It was exciting to learn that despite some hurdles, this mHealth pilot was an initiative supported by the government of Nepal.

We are excited for the future of mHealth in Nepal and wish GIZ all the best in their continued success! We are also excited to welcome six more participants from GIZ Nepal in our upcoming Technology for Monitoring and Evaluation course in January to better measure the impact of this mHealth pilot! It is wonderful to see how GIZ is committed to mHealth and M&E through their investment in technology capacity building in Nepal.

In honor of World AIDS Day 2014, we celebrate several TechChange alumni who are heroes in the front lines of fighting HIV and AIDS across the world. From their communities in San Francisco, Vietnam, Malawi, South Africa, and Zambia, these extraordinary individuals are using mHealth technology, online training for HIV preventing, and more to save lives with HIV awareness campaigns through online trainings and SMS campaigns, Android mobile apps for accurately prescribing antiretroviral medication, and more. Check out the top five ways TechChange alumni are using technology to fight HIV.

1. Encouraging HIV testing and care in Vietnam with mHealth gamification programs
Caroline Francis and her team across FHI 360 Vietnam have launched mHealth pilot programs to encourage HIV testing and care maintenance through gamification with mobile phones. In their programs in Hanoi and Ho Chi Minh City, mHealth is a key strategy for FHI 360 “to incentivize health-seeking actions, increase the timeliness of data collection, improve patient communications, and document system-client interactions. MHealth can also facilitate workforce development through task shifting, performance support, and human resources management.”

Check out this video on their “Fansipan Challenge” mHealth pilot program here.

2. Promoting HIV support group and health management classes with SMS reminders
In her blog post on “mHealth: Healthcare Reaching Remote Places with Mobile Phones and SMS”, Reverend Neelley Hicks describes the success of a community health worker’s use of SMS messages to remind HIV+ members of a community in Malawi to attend support group and HIV health management classes. The significance of reaching these program beneficiaries was not small, as “community health workers often must walk miles to find someone only to learn they are away. But the mobile phones stay with the person – making them much easier to reach.”

Mercy-mHealth-United-Methodist-Communications

Mercy (pictured with Maeghan Ray Orton from Medic Mobile) at UMCom workshop in Malawi

3. Scaling HIV Prevention in California via eLearning
A&PI (Asian and Pacific Islander) Wellness Center, a San Francisco-based organization with that started to fight the HIV/AIDS crisis in A&PI communities beginning in the late 1980s, collaborated with Project Inform and TechChange to develop the California Statewide Training and Education Program (CSTEP), a curriculum that sets the standard in HIV treatment and technically and culturally competent training for clinical and non-clinical providers working in the HIV field. The A&PI Wellness Center works to address the health needs of marginalized and vulnerable groups, regardless of race, ethnicity, gender identity, sexual orientation, or immigration status.

To register for these free online courses on HIV prevention training, please click here.

4. Correctly prescribing HIV antiretrovirals (AVR) drugs with an Android smartphone mobile app in South Africa

To help clinicians to correctly prescribe antiretrovirals, Dr. Musaed Abrahams, an alumnus of our mHealth – Mobile Phones for Public Health online course, has launched a mobile app for managing antriretroviral treatment (ARV) medication in South Africa.

The Aviro HIV mobile app acts as a virtual mentor for clinicians to easily consult for proper ARV (Anti-retroviral) initiation and treatment during the patient consult. Designed for Android and based on the current South African guidelines, it provides real-time, immediate feedback and guidance for the clinician, so that excellent and reliable care can be delivered to every patient. Following a care checklist, it gives clinical prompts aiming to educate and raise the standard of patient care.

Download the Aviro Android app on the Google Play store here.

5. Advocating for reproductive health education in Zambia with SMS
After taking several online courses with TechChange, Priscilla Chomba-Kinywa created a SMS solution called U-Report to promote sex education to prevent HIV in Zambia among youth. She incorporated the feedback from Zambian youth in the process of building out this campaign and program. The first year of the program’s pilot in 2 provinces had 50,000 young people voluntarily sign up and engage the 24/7 trained counselors by asking them questions on HIV, sexually transmitted infections, and other reproductive health issues.

Want to learn how you can use technology to address challenges such as HIV and other global challenges? Enroll in one of our online courses here and get $50 off any course with the coupon code, ENDAIDS2014, before December 5, 2014.

Hamlet (community) health workers in Vietnam learn to interact with mCare (Photo credit: FHI360)

With international development program cycles often having a “project design phase”, how can online learning as a team improve project design?

How do you design a technology program intervention to improve health outcomes?

HIV Challenges and Keeping Up with mHealth

According to the WHO, HIV has claimed 39 million lives so far globally with 1.5 million lives in 2013 alone. At the end of 2013, there were 35 million people living with HIV, with 2.1 million becoming newly infected. With 24.7 million people living with HIV in 2013, Sub-Saharan Africa is the most affected region in the world accounting for almost 70% of the global HIV infections.

HIV often gets highlighted as a major problem in Sub-Saharan Africa, but it is also a major public health concern in Southeast Asia, particularly in Vietnam where the use of needles to inject drugs drives the epidemic. As of 2012, 260,000 (of the 89 million) people in Vietnam are living with HIV, according to UNAIDS Vietnam. As a result, FHI 360 is working with the Government of Vietnam to address the country’s HIV challenges with “effective programs that cost less, are implemented locally, and decrease donor dependence”.

Technology developments in public health change very quickly, especially with the emergence of mHealth – there’s more mHealth programming, new applications, and emerging research.

MHealth is a key strategy for us as these applications can be used to incentivize health-seeking actions, increase the timeliness of data collection, improve patient communications, and document system-client interactions. MHealth can also facilitate workforce development through task shifting, performance support, and human resources management.

According the blog Tech in Asia, “For every 100 Vietnamese people, there’s 145 mobile phones. For a country whose population is just over 90 million, that amounts to more than 130 million mobile phones.” RefWorld.org reported that, as of January 2012, census data indicated there were 119 million mobile users in Vietnam when the population was at 88 million. Given the emergence of the mHealth industry and the large percentage of the Vietnamese population with cell phones, we at FHI 360 need to effectively mobilize this ubiquitous technology for impactful programming that helps individuals in all areas of the country protect their health and well-being.

A Social Online Learning Solution

In 2012, I first participated in TechChange’s 4-week online certificate course called “Mobile Phones for Public Health.” I decided to take the course again in 2013 – this time with numerous colleagues — to share our mHealth programming experiences and to continue to learn from renowned mHealth practitioners around the world.

Like all busy development professionals, it is difficult to find time to cultivate learning during our day-to-day work. The TechChange course was structured and delivered to meet our needs.

Here’s a social graph from Mobile Phones for Public Health showing participant interaction

Cutting-edge, timely, and relevant information

TechChange updated its courses at least once every 3-6 months, based on direct feedback (through crowdsourcing and surveys) from its broad learning community to deliver the most up to date and relevant course content.

Great format for busy working professionals in Vietnam and beyond

Keeping our busy schedules in mind, the course content was designed to be mobile and tablet-friendly, allowing us to learn wherever and whenever fit our schedules. All live events were recorded so that learners could access materials according to their schedules.
For those of us who had difficulty finishing the course in the one-month period, access (and technical support) is available for four months after the end of the course so that we can complete our final project and receive the formal certificate.
The online interface was the most intuitive learner platform we have ever used: An online course map visually illustrated all components of the program, while a calendar highlighted a variety of live discussion events with renowned experts from around the world.
The main facilitator actively participated in all discussion boards; introduced weekly themes (through video, email and platform) and summarized (through print and video) the highlights of each week. He and a facilitation team also provided “office hours” for those who needed extra support (and this support was provided in various time zones).

Interactive learning experience

There was great communication between facilitator and learners. The course required 7-9 hours of effort per week and the 50 or so participants were motivated to actively participate. Learner outcomes were clearly defined and each week’s themes were well-articulated so that we knew what to expect and what was expected from us.
Instead of relying primarily on print materials, sharing video, audio and weekly live events/”chats” allowed learners from various cultural backgrounds to gain knowledge and skills through a variety of channels through interactive learning.
Practical exercises and interactive simulations ensured knowledge application and exchange.
Individuals got to know each other through a variety of “get to know you” activities and collaborative exercises.
TechChange added some fun by integrating game dynamics into the course, awarding points each time a person participated in a discussion or attended an event, with a minimum participation threshold established in order to earn a certificate.

Joining a professional network and community

All learners also became TechChange alumni upon finishing the course. We are now connected through social media with others in mHealth (and offered substantial discounts on upcoming courses).
It’s been great to see other mHealth alumni like Lauren Bailey making strides in the field after joining this course.

Here are some additional comments from two of my colleagues:

“I really enjoyed reading the forums at my own pace. I liked that other participants put so much thought into them.” – Deen Gu

“I like the discussion parts most as they offer me many interesting thoughts and experiences of TechChange’s members on different topics.” -Nguyen Thi Van Anh

As a recent graduate of TechChange’s courses, I can speak to the benefits of participation.

USAID/SMART TA team provides hands-on training to hamlet health worker in Nghe An (Photo credit: FHI360)

Results of mHealth Training with TechChange

Through this mHealth course, my team learned best practices as a group to explore ways to implement mHealth projects. My colleagues learned how mobile technologies are being used in other countries and sectors and thought about ways it could be applied in Vietnam. The individuals who have participated in the TechChange course are now our office mHealth champions and are actively identifying areas of work where mHealth solutions can be applied.

Here are two current mHealth pilots we have launched in Vietnam through the USAID/SMART TA program to address HIV challenges:

1. Fansipan Challenge – uses the metaphor of Fansipan mountain (Vietnam’s highest peak), gamification, and mobile technologies to support people who inject drugs and their intimate partners to test for HIV and be linked to care if they are positive.

Fansipan was created by USAID funded SMART TA project in Vietnam. Learn more about SMART TA here.

Here is a Prezi presentation explaining the Fansipan project in Vietnam called How Mobile Technologies and Gaming are Improving HIV Program

2. mCare – is the first case management application in Vietnam that utilizes mobile technologies to support and track clients across the cascade of HIV outreach, testing, care and treatment services. It also manages performance-based incentives for hamlet health workers who identify potential clients, encourage them to test for HIV, and support them to enroll and be re-engaged in HIV care and treatment and methadone maintenance treatment.

A confirmation message sent from mCare (Photo credit: FHI360)

The Results of the mHealth Pilots So Far

While mCare is in its early stages of deployment and refinement, the Fansipan Challenge has shown a dramatic reduction in programmatic unit costs, combined with significant increases in testing uptake and HIV yield among underserved key populations. Between June – November 2013, 62% of 656 injecting drug users and their intimate partners tested for HIV after a single contact. Approximately 71% of these individuals were first time testers; 17.8% were diagnosed as HIV positive. Comparative expenditure analyses of USAID/SMART TA-supported outreach services show a 50% reduction in costs associated with identifying an HIV positive person. And preliminary data further suggest that HIV positive people identified through Fansipan have higher CD4 levels (average 287.5 cells/mm3) and will thereby have better treatment outcomes than those who initiate treatment when they are severely immuno-compromised.

These new initiatives rely on mobile technologies and we, like other technical assistance providers in the development sector, need to be constantly learning about mHealth innovations, and emerging knowledge and applications. The TechChange mHealth class was a great investment in having my team become more familiar with mHealth as we introduced our mHealth initiatives.

About Caroline Francis

Caroline Francis is FHI360’s Deputy Country Director in Vietnam and completed TechChange’s Mobile Phones for Public Health course in 2012 and in 2013 when she took the course again with her team in Hanoi and Ho Chi Minh City. She is currently involved in FHI360’s Sustainable Management of the HIV/AIDS Response and Transition to Technical Assistance (SMART TA) project in Vietnam and her areas of expertise include HIV and AIDS prevention and care and Social and behavior change communications. Caroline has previously worked as the Associate Director (HIV Prevention, Mitigation, Strategic Behavioral Communications and M&E) and Deputy Director for FHI 360 Cambodia. She received her M.A. in Anthropology from University of Victoria.

Text to Change’s Chief Technology Officer, Marcus Wagenaar, sat down with me yesterday to discuss new projects on the horizon and innovations in the mHealth field. Text to Change is an international NGO which uses technology for social change, or as Marcus puts it, “not just a tech company.” Instead, outreach is where Text to Change works. As the knowledge bearers about mHealth systems and needs, they help design, conceptualize, manage and analyze outreach and projects with their implementing partners to address gaps in healthcare systems and information.

I asked Marcus to talk a bit about some of his favorite projects:

m4rh

Mobiles for Reproductive Health (m4rh), in collaboration with FHI, uses SMS and web based software to send targeted messages about reproductive health. The user gets their first message and is given 1-3 options for response, such as “if you want more information about condoms, text back 001.” They are then inside a tree of responses win which they can navigate back and forth and discover new information. The project has been running in Kenya and Tanzania for over a year with pilots in Ghana and Rwanda underway. FHI provides the content and updates, Text to Change runs the IT backend in each country, all from Kampala.

m4rh is one of Marcus’ favorites because it’s “inherently scalable, once it’s set up anyone can access it for free by texting the first keyword to get the main menu” and it’s the “perfect example of Text to -Change because it provides people with information to make informed choices about their lives. In situations where information is lacking or inaccurate around sensitive issues of reproductive health, m4rh allows people to access information that can give them more control over their lives. They still make their own decisions but at least they have all necessary information to make an informed choice.”

As example of its popularity; in May 2012 more than 40 thousand people have accessed the M4RH information service in Kenya alone. The specific information people access in the system is analyzed. Also, SMS surveys amongst users are carried out to enable deeper analysis of behavioral patterns. By combining this information various things can be deduced. Examples are: which contraceptives are popular in which age groups, what are the differences in male and female use of the system, are the choices people make influenced by the system, etc. These research results or not yet in the public domain but have been shared at various mHealth conferences and we hope to be able to share the results with a wider audience in the near future.

Medical Male Circumcision

The Medical Male Circumcision project, in partnership with Jhpiego in Tanzania and potentially Uganda, is a service hat sends information, similar to m4rh, as well as supporting patient recovery. Individuals in the beneficiary population get messages regarding where they can receive Medical Male Circumcision and why it’s important, such as “Male circumcision can reduce the risk of female-to-male HIV transmission by 60%”. After surgery, patients receive messages as soon as the surgery is complete regarding what to expect during their recovery. The Medical Male Circumcision project provides a Virtual Nurse who advises patients: “Make sure that you do not have sex for the first two days,” for example, or later on in the recovery “if your urine is discolored, visit the clinic.” The messages are “specific but lighthearted” with quiz questions every week to engage the patients and to assess how much they know about Medical Male Circumcision. Messages are meant to be encouraging and a “positive way to ensure recovery,” reduce stress, and “decrease health costs overall” by addressing concerns before they become serious health issues.

Text to Change monitors how many people they reach with their messages, how often they are reached, and how much it costs to reach a person. Researchers were able to show a statistically significant association between those men who texted in to the toll-free number asking where male circumcision was available and those who actually followed through and got circumcised. This is a good example of providing people with information to help them making informed decisions about their own health.

Data Collection

The data collection project is in the pilot phase with the Center for Disease Control in Tanzania within the mHealth Alliance. The project targets mothers after they have delivered and will speed up data collection about Vertical or Mother-to-Child-Transmission (MTCT) of HIV. Currently, midwives and nurses fill in registers for mothers and babies to track their data by hand. The individual patient data is rarely analyzed and often inaccessible to researchers and government representatives so that today there is no reliable number for the transmission rate for MTCT in Tanzania. This Data Collection tool pilots a new form for tracking MTCT data, where healthcare workers take data from the standard register, write it on a worksheet and then copy it line by line and send it to a central location using SMS. The data collected will allow the CDC to calculate the transmission rate for the first time in Tanzania and will enable impact evaluation of interventions that aim to lower the number of Mother to Child Transmission of HI, which is part of the Millennium Development Goals.

I also asked Marcus to give a window into exciting innovations in the pipeline:

FormHub

FormHub is an Open Source initiative by Columbia University. Text to Change is working with Columbia to develop and use their platform in the field. Text to Change is currently implementing this technology with one of their partners. The partner will conduct a survey in Uganda’s Luwero District, interviewing 1000s of teachers and students in secondary school about physical abuse, sexual abuse, living conditions, and emotional and physical wellbeing of children. This is the first ever large-scale survey about these sensitive issues performed in Uganda. The partner designs the survey questions, Text to Change enables easy data collection using mobile technology and the formhub platform. Using cheap Android phones, 60 trained Ugandans will carry out the survey using FormHub.

Marcus also wants to use FormHub to automate data gathering in health and medical setting in remote clinics because it’s simple to use for the designer, data collector and data analist and it’s open source. Many more interesting projects to come!

Vusion

Vusion is a new SMS open source platform development by Text to Change. The backend is based on the Vumi system developed by the Praekelt Foundation. Marcus sees Vusion as the next big thing in SMS messaging, and here’s why:

Vusion is focused on providing a scalable enterprise messaging platform
It can connects to multiple telecom companies and aggregators in multiple countries and multiple shortcodes
Once Vusion is set up, you won’t need a programmer to design campaigns or access data so it’s easy for non-technical project managers to use without programming skills
An API enables access to SMS data from external applications, which enables easy development of for example; advanced real-time data visualizations, website-widgets, twitter integration, etc.
Vusion has different access levels and enables organizations to implement and manage multiple SMS programs in parallel from one central platform.

Programmer? You can download Vusion from github and see what the skeleton looks like.

Some of the cost implications of SMS projects are annual dedicated shortcode fees and aggregator costs. Vusion reduces this by enabling shortcode sharing. Users can use the same shortcode for small projects to share infrastructure and still be in full control over their campagins and projects This is the approach Text to Change has been pioneering for years but Vusion will make it easier for organizations to be more involved in their own campaigns by having full access to their projects and the associated data.

Vusion was launched with an extensive demo on the 15^th of June in Amsterdam. There is no recording of real-live demo but an accompanying presentation is available on slideshare.

Interested in learning about Mobiles for International Development? Check out our upcoming course, mHealth: Mobile Phones for Public Health, starting in November.