UK Research and Innovation | Survey

1st Submission Bronze Trophy

mHealth: The Nurse Assistant & Patient App

The limited number of health workers, equipment, transportation and ambulance service, inadequate data sets on maternal health care, lack of structure and regulation in maternal programs, and the limited number of maternal health services at district level are among the myriad challenges in the health sector in sub-Saharan Africa. Maternal mortality and morbidity are still high and one of the biggest health burden (WHO, 2015). It is estimated that 99% of maternal deaths occur in developing countries of Sub-Saharan Africa and South Asia (WHO, 2015). Inequalities within the health sector operate across various levels and layers.

How could digital technologies provide a solution to this challenge?

The solution proposed: A mHealth solution to be used in Android mobile phones or tablets by frontline health workers (Community Health Nurses in Community-based Health Planning and Services zones). The solution is Cloud-based and uses the available mobile communications network in the facilities. It is focused on providing a pregnancy monitoring system, bridging the distance between facilities and communities. Included also in work routines, to be used in facilities and community visits

BHUVANA K.B 1 month ago

What are the specific things you want to monitor? Is it high risk cases of in general all cases? What facilities will be given through technology?

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Cyril France 1 month ago

Hi Bhuvana, Thanks for your interest and questions. To monitor pregnancies, with regards to facilities or technology, equipping Community Health Nurses with a mobile phone or tablet and equipment needed to monitor pregnancies, ought to be available. Decision support systems and data gathering services are included. That will help develop birth plans based on real evidence to increase skilled birth attendance. The application will allow information sharing among facilities, track patients and improve collaboration among professionals. Health Administrators will be provided with data summaries, indirectly improving emergency systems. The system should work offline and asynchronously will send the information to the server whenever connection is available.

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BHUVANA K.B 1 month ago

This is good. Information sharing between sectors and health care providers- how are we dealing with confidentiality? Is it good idea to take patient consent or agreement on sharing data?

Is it only maternal or even neonatal data/ outcomes?
Maternal outcomes- number of live birth, vaginal deliveries, c section, infections, complications of disease, still births, abortions? By increased utilization of health care services, better outcomes?

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Cyril France 1 month ago

Dealing with confidentiality and patient consent... are indeed valid points. That's one other gray area that requires further legislation. The challenge of data privacy is to use data while protecting an individual's privacy preferences and their personally identifiable information. The fields of computer security, data security, and information security design and use software, hardware, and human resources to address this issue. Adherence to ethical standards of practice is also key. Neonatal data/ outcomes could is obviously part. Thanks for your comment.

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BHUVANA K.B 1 month ago

May be high risk cases like ecclampsia, gestational diabetes, HIV, Tuberculosis etc these patients would benefit largely in terms of improving on medication adherence, patient education along with remote monitoring. They should be provided BP monitoring device, glucometers to improve self care Maintainance and management. Also mHealth should have an option about notification box, about emergencies and hospitalizations.

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Cyril France 1 month ago

Hi Bhuvana, Thanks for your comment. I appreciate your fundamental viewpoint. You raise some pertinent points. The aim of this project is to enhance the capacity of the maternal health care system in rural areas and increase Maternal Health Care utilization. The application will allow information sharing among facilities, track patients and improve collaboration among professionals. Health Administrators will be provided with data summaries, indirectly improving emergency systems. System should work offline and asynchronously will send the information to the server whenever connection is available. Cloud services are accessible and allow remote maintenance of the network.

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BHUVANA K.B 1 month ago

Hi Cyril, Thank you for responding.

Health systems as a whole should be put into place. (WHO building blocks of health systems components needs to be strengthened) - includes leadership and governance, health workforce, service delivery, finance, technology, information and research- at all 3 levels, micro macro meso, vertical and horizontal integration)

May be maternal health care programmes should be evaluated and monitored as a first step. Then mHealth application can be used to improve the utilization of services through strengthened infrastructure (both functional and structural)

Utilization includes free medicines and vaccines? Iron, folic acid, calcium, tetanus vaccine and other optional vaccines. Routine antenatal check ups, investigations etc?

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Cyril France 1 month ago

Hi Bhuvana, I couldn’t agree more. Health systems as a whole should be put in place. With regards to utilization, I wouldn't necessarily equate it to free medicines and vaccines. I'm somewhat skeptical about "freebies" since free or donations are often used as a way to make others ‘pay up.’ Free medicines and vaccines can also undermine long-term efforts to increase access to affordable vaccines and medicines. They remove incentives for new manufacturers to enter a market when it’s absorbed through a donation arrangement. Critically, donation offers can disappear as quickly as they come. The donor has ultimate control over when and how they choose to give their products away, risking interruption of programs should the company decide it’s no longer to their advantage. For example, Uganda had to experience a nationwide shortage of Diflucan, an essential crytpococcal meningitis drug, in spite of Pfizer’s commitment to donate the drugs to the government. There are other similar examples of companies’ donation programs leaving governments and health organizations in a lurch without the medical tools they need to treat patients (MSF, 2016). You may want to read the attached file. Thanks again for raising this important point.

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BHUVANA K.B 1 month ago

Thanks for explanation.

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Cyril France 1 month ago

I just realised that the file wasn't attached, please find via this web link: wasn https://medium.com/@MSF_access/there-is-no-su...ia-6a79c9d9f32f

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lauren clarke 2 weeks ago

Status label added: 1st Submission Bronze Trophy

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Cyril France 2 weeks ago

What are your thoughts on this idea, the mHealth: The Nurse Assistant & Patient App?

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Josephine Muchogu 1 week ago

Hi Cyril,
This is a fantastic idea.
The limited number of health workers translates into over-worked (and often times overwhelmed) health workers. Is it possible for the app to automate certain (non-essential) functions by providing templates and checklists?
Is this what is entailed in "protocol driven guidance"?

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Cyril France 1 week ago

Hi Josephine,
Thanks for your comment. Indeed, it is important for the app to draw on the best available evidence, taking into consideration patient feedback, midwives’ preferences and shared approach to practice, local needs and limitations. Yes, contained in the protocols are the clinical approach, templates, checklists, etc.

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Cyril France 2 weeks ago

What are your thoughts on this idea, the mHealth: The Nurse Assistant & Patient App?

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Osu 2 weeks ago

mHealth has been talk about and it will alleviate limitations facing the sector especially places with accessibility problem.

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Cyril France 2 weeks ago

Hi Osu,
That is a valid point.I fully agree.
Thanks, Cyril

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Pamela Wadende 2 weeks ago

Hi Cyril, This is a great idea for most women who live and have their babies in rural areas in Sub-Saharan Africa that are most affected by inadequate and even scarcity of maternal health care services. I wonder how this would work out in urban areas among a vulnerable population ie those that live in poor neighborhoods and may not afford/or access health care staff to have their pregnancy term monitored in the available facilities. They may live not far from a health center but not afford the service or only be able to attend half the recommended sessions. I see a population that is not served because they live in n area believed not to need this kind of service. Could this technology need an addition number of staff in these facilities that concentrate on it specifically?

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Cyril France 2 weeks ago

Hi Pamela,
Thanks for your comments. You raise a number of pertinent points. Indeed, there are vulnerable communities and groups in urban areas. In fact, the pilot phase of the app is to test and make modifications in a more targeted way to reach the most vulnerable population. Vulnerable populations in urban areas would be targeted during the scaling up. I agree with your overall point, paying insufficient attention to other groups which might be excluded can foster misleading perceptions about the real relevance and (potential) effectiveness of the app. Thanks again for your interest in this post.
Best,
Cyril.

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Cyril France 1 week ago

What are your thoughts about this idea, the mHealth: The Nurse Assistant & Patient App: https://ukri.crowdicity.com/post/781520

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Emmanuel Arakpogun 4 days ago

Hey Cyril, a very interesting proposal. Also see 'BabyCenter' and 'MAMA' (https://globalvoices.org/2016/11/28/facebooks...-47-countries/) as well as SaferMom (https://safermom.com/)
While these innovations are promising, the practice of some African governments imposing taxes on OTTs, which powers/partners some of these applications, is not helpful. Furthermore, as I highlighted in my recent blog, for people to access these innovations, they need to have access to mobile telecoms. Since this is lacking in places, the scaling and impact of these innovations would be limited.

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