Design to Eliminate Mother to Child Transmission of HIV

by John Ryan (UNICEF Fellow) and Erica Kochi

Today at the mHealth Summit, UNICEF, frog and partners (Johnson & JohnsonElizabeth Glaser Paediatric AIDS Foundations and the mHealth Alliance) launched the report on mHealth strategies to strengthen collaboration and increase the impact of elimination of mother to child transmission of HIV (EMTCT) initiatives

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The report shows how mobile phones can change the way health-care is delivered in the most rural and underserved parts of the world. There is now a way to have real-time, two-way communication with communities that are beyond the periphery of formal health systems. At the September 2012 International AIDS Conference, UNICEF, frog and partners  brought together key stakeholders in public health, mobile health (mHealth) and design communities to explore how mHealth can play a role in the prevention and elimination of mother to child transmission (EMTCT) of HIV. This one-day collaborative workshop built on the real-time data model developed by UNICEF in the 2011 workshop on Community Case Management, which was also facilitated by frog.

The workshop consisted of a number of hands-on activities that encouraged participants to think creatively about how mobile technologies might be leveraged to support mothers, children and health-workers along the continuum of care in interventions to reduce the maternal transmission of HIV/AIDS .

Read John Ryan’s (UNICEF Fellow) impressions of the workshop below:

Introducing the 1,000 days Framework

Following a welcome from Patricia Mechael (Executive Director of the mHealth Alliance), Robert Fabricant (Vice President of Creative at frog design) introduced the framework that would form the basis of the workshop.

Robert Fabricant introducing the Framework

The framework builds on the work we’ve been doing at UNICEF to use the Continuum of Care as a linchpin in UNICEF’s global mHealth Strategy. You can read more about this in this previous blog post. We developed it to ensure that planning and communication around UNICEF’s mHealth projects remains focussed on the necessary health interventions and support that mothers and their children need, particularly during the critical 1,000 day period. The 1,000 days between a woman’s pregnancy and her child’s 2nd birthday offer a unique window of opportunity to shape healthier and more prosperous futures. The visual framework we created has proven particularly useful in mapping the various points of contact the mother and child have with the health system during this critical period.

The framework’s potential was recognised by key partners, including frog, Johnson & Johnson, and the mHealth Alliance, who suggested that the EMTCT workshop might be a good opportunity to apply the framework. Developing our initial work, frog created a tool for the workshop using the 1,000 days framework to outline challenges and mobile opportunities in relation to mother and child experiences, as well as WHO and UNICEF policy guidance around interventions. The workshop provided an opportunity to test the framework and gather some further feedback for its future development.

To make participants aware of a number of mHealth initiatives in the EMTCT space, as well as introduce the framework, we created a series of posters (view PDF) mapping these projects along the framework.

PMTCT mHealth Project Posters

Exercise #1 – Empathy

For the first exercise, we stepped into the shoes of a mother or community health worker (CHW). In small groups, we sought to get a sense of their daily life, their needs and how mobile technology might offer solutions to the problems they experience along this 1,000 day journey.

Developing the Persona

We built up a specific persona, by answering key questions about the individual at the centre of our story. With the details of this person’s life in mind, we then began to map their journey out, identifying the needs, frustrations and problems that they encountered along the way. These specific ‘pain points’ became opportunities for suggesting how mobile solutions might offer some solutions. Adopting the perspective of the mother (or CHW) helped us to focus on innovations that would provide actual benefit for her, without adding unnecessary complexity.

Mapping the Mother's journey

Exercise #2 – Drivers

Discussing these mobile opportunities as a large group, we mapped them onto the framework across a number of focus areas. For example, did they deal with tracking mother/baby pairs? Or did they tackle problems to do with lack of information?

Mapping Mobile Opportunites

We also identified existing mHealth projects working in the same focus areas, and added them to the mapping. Sharing existing mHealth projects will be essential to the adoption of mobile tools by a larger audience—communicating which interventions have proven results, and which tools and techniques can be used and adapted.

As well as the user-centred focus areas that had been initially suggested, we also identified broader “Health System Strengthening” focus areas, such as quality of care and service coordination. The former focus on the needs of the mother and child but the later support the health system that is caring for them.

Exercise #3 – Priorities

During the second half of the day, we switched our point of view to that of a District Manager. We imagined what information from mobile interventions might be valuable to him in his dad-to-day management of his district’s health system. If he had a dashboard updated with realtime data from mobile interventions, what information would he want to see?

Each group focused on one of the key focus areas from our previous exercise, considering what data points might be taken from the mobile actions that had been suggested.

District Manager Dashboard Session

Exercise #4 – Reflections

The day finished with feedback on what key take-aways participants had, and how what they had learnt might influence their work going forward. Many spoke about how they had found new ways to look at problems—both from a system-wide level and through the eyes of end-user on the ground. Others expressed a desire to continue working in this collaborative manner, creating more opportunities for the wider mHealth community to work together in similar creative sessions.

Because the day had also served as an opportunity to test the 1,000 days framework, we spent some time at the end of the day feeding-back on the strengths and weaknesses of this version of the framework. This feedback has been captured by UNICEF, frog and other partners, who will continue to refine and develop the framework for further use.

Karin Little, John Ryan, Merrick Schaefer and Adaku Ejiogu

Personal Reflections

For me personally, it was an exciting day to have been a part of. Primarily, it was a privilege to take part in generating ideas that might go on to inform life-saving innovations. But it was also inspiring to see how the simple visual framework that we had developed here at UNICEF began to grow, mature and take on a life of its own. It was great to see where it had failed—where problems or shortcoming appeared during its use—as well as where it was useful.

As mHealth tools are adopted and used by a wider community, I believe that tools like this visual framework will be invaluable in a number of ways:

  1. To ensure implementors focus on the end-users and aren’t distracted by the technical aspects of mobile solutions.
  2. To provide a model for how mHealth solutions might work together across regional, organisational and programmatic areas (providing the opportunity for unified/integrated systems, shared resources and knowledge, etc.).
  3. To provide a common framework for communicating what existing tools offer and how they work, particularly to those new to mHealth.

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