In addition to seeing cool gadgets and new uses for technology, one of the most interesting parts of the mHealth Summit has been hearing people’s lessons learned. Allison Stone, MoTeCH project manager, and Maggie Schmitt, project officer, sat down with me to share their experiences working on MoTeCH, a mobile phone-based electronic medical record system that generates alerts and reminders to pregnant parents and frontline health workers in Ghana’s Upper East Region. The project is a partnership with Columbia University, Ghana Health Service, and the Grameen Foundation.
One of MoTeCH’s greatest strengths is undoubtedly its software, a comprehensive system for capturing health information to facilitate the continuum of care during pregnancy and early infancy. This open source software is currently one of the most comprehensive systems available. Using data captured by community health workers on inexpensive phones, MoTeCH provides feedback to these workers and their clients and generate the workers’ monthly reports (which can normally take up to five days to prepare manually).
One of the unexpected challenges encountered by the project has been lower cell phone access and lower familiarity with using phones than expected. Initial reports showed that 75% of households in the target district have a cell phone, but women may not have access to men’s phones, and phones may not always be charged and turned on, for instance. Despite the fact that many women do not have phones or do not know how to use phones, qualitative data shows that women who have reliable access to a phone are very enthusiastic about the MoTeCH messages they receive. Women receiving the messages have said they have prompted them to obtain better nutrition during pregnancy, deliver in a health facility, and practice exclusive breastfeeding. Furthermore, other members of the household listen to MoTeCH messages, increasing awareness among partners and elder relatives about health needs during pregnancy and early infancy.
Introducing community health workers to data entry on a mobile phone has been challenging, as cell phone data entry is a significant change from their routine and is also time consuming. Alerts and reminders to providers may be useful, but they are not always accurate if data entry is not done completely and accurately. Since community health workers do not receive immediate benefits from MoTeCH, they have been less inclined to use MoTeCH; however, the simplified paper registers, designed as an intermediary step towards a standardized heath information platform, have been widely used and appreciated.
MoTeCH has experienced a number of implementation challenges, including lack of provider motivation to enter data into phones and women’s unanticipated low access to phones. There have also been some difficulties integrating MoTeCH into the larger health system. MoTeCH has mitigated some of these challenges by involving Ghana Health Service managers and supervisors to monitor health worker participation, data entry, and data uploading.
Allison advises anyone beginning a mHealth project to conduct thorough preliminary background research to really understand the target population and patterns of cell use among this population. Rather than introducing a new way for people to use phones, interventions should be designed so that they fit closely with how people already use phones.