Leveraging RapidSMS to Support Health, Nutrition and the elimination of mother-to-child transmission of HIV in the Last Mile
With the launch of the global Scaling-Up Nutrition (SUN) initiative, UNICEF is developing a mobile service product to support essential interventions in the 1000 days between a woman’s pregnancy and her child’s second birthday. Although SUN and its 1000 Days initiative are focused on nutrition, UNICEF seeks to strengthen front-line health services by providing mobile services for support across the entire continuum-of-care throughout the same time period. This support includes mobile services for growth monitoring, antenatal & postnatal visit reminders, HIV/AIDS lab results delivery, and supply & logistics support for essential medicines. UNICEF believes that a holistic approach will increase efficiencies and improve health outcomes for mothers and children.
Many of the necessary mobile services already exist in various UNICEF RapidSMS deployments, such as Project Mwana, AnthroWatch, mTrac, Antenatal Care and others. In order to streamline the replication and rapid scale-up of these high-impact mobile services, UNICEF is developing an open-source mHealth product powered by RapidSMS for efficient national-scale deployment in six initial target countries. The key objective will be to develop a flexible eHealth / mHealth software product based on existing platforms, and improving general interoperability with other eHealth / mHealth systems.
By focusing efforts on a common product, UNICEF country offices will achieve greater efficiencies and effectiveness in software development, training, and operations. UNICEF will build relevant competencies throughout the organization and will be able to engage with external partners and software vendors more effectively at a global scale. Developers will avoid duplication of effort and will build expertise and experience working with an actively developed, globally supported software system.
Core Product Features
- Lab result delivery for HIV/AIDS and other testing
- Reminders for mothers & health workers throughout pregnancy and after birth for scheduled appointments and other events
- Growth monitoring & nutritional surveillance
- Supply & logistics tracking for health facilities and warehouses
- Interoperability with other eHealth / mHealth systems via included patient level data APIs, aggregate data APIs, and facility APIs
Product Development Overview
- Extract core 1000 Days services from existing deployments. Update with additional installation and configuration improvements.
- Define internal and external APIs for patient level, aggregate, and facility data. Implement web services to provide these data to the core 1000 Days services. In some deployments, web services may simply run alongside the core services; in other deployments these web services may remotely access required data in existing open source eHealth / mHealth systems such as CommCare, MoTech, OpenMRS, and DHIS2.
- Develop a robust software update framework to easily keep deployed services up-to-date with the latest improvements from other deployments.
- Develop mobile services for additional interventions or support areas, such as birth registration, community management of acute severe malnutrition, micronutrients, immunization etc. Develop additional APIs and web services for deeper integration with external eHealth / mHealth systems as well as national/governmental data systems.
Programmatic and Operational Context
To ensure healthy outcomes in underserved communities, households need to be able to access essential health, HIV and nutrition information and services for pregnant mothers and their children along the continuum-of-care. To bridge the access gap to basic healthcare, Ministries of Health increasingly rely on front-line Community Health Workers to link these mothers and their children to the larger health system. Technologies such as mobile phones offer an unprecedented opportunity to address longstanding bottlenecks that have long been a barrier to healthy outcomes.
UNICEF and partners have demonstrated that integrating mobile technologies into health systems can help overcome bottlenecks. Particularly – strategic use of technology can solve problems of time, distance and coordination in the delivery of health services. Solving these issues can provide opportunities to better link community health services to the formal health system in underserved and remote communities, and offer the ability to directly target and interact with even the most remote health consumers. In addition, by integrating mobile, these transactions are captured in real-time and can be seen in aggregate at district and national levels, allowing for real-time programme management.
Many of these mHealth initiatives have focused on addressing bottlenecks within a single vertical programme. These innovations may not always link to foundational eHealth systems such as DHIS2 and OpenMRS being adopted by partner governments, however they share many underlying commonalities that could make such linkages possible. We believe that can be implemented as a common product to support the delivery of health, HIV/AIDS, and nutrition services across the continuum of care.
A common, open-source mHealth product, coupled with larger eHealth systems, will decrease barriers to entry for UNICEF and partners to employ these technologies within programming, reduce duplication and costs, and promote replicability and adoption.
An example of how mHealth tools can support maternal and child health longitudinally across the continuum-of-care:
UNICEF’s work in this area focuses around:
- Generating Demand: Empowering Community Health Workers by implementing mobile solutions that support and recognise their work, link them with the formal health system, and help them deliver a better quality of care.
- Ensuring Supply: Using the information that national m-health systems can generate to better manage programmes in real time.
The 1000 Days product will follow WHO/UNICEF recommended interventions, standards and guidelines around maternal, neonatal and child health, nutrition and HIV/AIDS, and will be based on existing implementations, design iterations, and lessons learned from deploying these mHealth solutions across various countries.
Several scenarios will be handled by the product that highlight the ways in which the 1000 Days product, coupled with external eHealth / mHealth tools, can provide capabilities above and beyond those of a single custom service. An example scenario from Zambia related to lab result tracking is illustrated below.