Helping Mothers, Saving Babies Through New Technology
APPROACH AND METHODOLOGY
mothers2mothers and HP will work together to develop new technologically-enabled solutions that will have generalized outcomes in: tracking, monitoring and evaluating; and improving follow-up of clients.
In order to track clients’ uptake of services along the PMTCT cascade and allow Mentor Mothers to pursue active and targeted retention of clients, a unique client identification number and new client data collection tools need to be designed to enable us to track client through inter-facilities referrals and regional migration. New data collection tools (paper and/or primary data input hardware), data abstraction tools (hardware) and a new Structured English Query Language (SQL) database designed specifically for the pilot will allow us to collect, enter, and report information on a much more timely basis. SQL (pronounced Sequel) is a standard interactive and programming language for getting information from and updating a database. This will, in turn, allow m2m and HP to design proactive (PMTCT appointment reminders) and active follow-up interventions for clients on a weekly basis by incorporating these activities into the Mentor Mothers’ daily activities at m2m sites. The new data collection tools will capture data similar to m2m’s previous M&E tools (paper-based logbooks) plus additional information specific to tracking client retention and uptake of priority services from first antenatal visit to 18 months after delivery.
In addition to client and facility data collected on sites in Cape Town, South Africa, during the pilot, m2m will also collect facility reporting and client data available at participating facilities for the previous 12 months prior to pilot implementation to allow us to compare and contrast pilot data to baseline data.
IMPLEMENTATION, TIMELINE, AND DELIVERABLES
Both m2m and HP will work in close collaboration throughout the implementation process. In the first month of the commitment, beginning 15th September 2011, m2m will refine client data collection tools by revising questionnaires. This will be immediately followed by another one-month activity on optimization of on-site data collection process for more efficient client tracking process flow.
HP will take the lead in providing technology platform by developing a Sequel Database that will provide electronic questionnaires for data entry via different access points, mobile technologies and active client follow-up support system. This will be implemented over a six-month period beginning 15th September 2011.
Once this has been completed, both m2m and HP will pilot and integrate mother and baby tracking technology at m2m field operations in pilot facilities for a three-month period ending 30th September 2012. Concurrently, m2m will prepare for roll-out and on-boarding process to implement/replicate client tracking technology to 10 additional sites in the Western Cape Province in South Africa.
2011 marks the 30th anniversary since the first case of HIV infection was reported. As we look back, remarkable gains have been made by science and medicine in saving lives of people living with HIV. Although significant progress has been made since the outbreak of the epidemic, there is still much work to be done.
In 2010, UNAIDS reported that 1.4 million pregnant women in resource-limited countries are infected by HIV, and 90% of these women are in sub-Saharan Africa. According to a WHO 2009 report, an estimated 2.5 million children were living with HIV at the end of 2009, 2.3 million of them in sub-Saharan Africa. Most of these children acquire HIV from their HIV-infected mothers during pregnancy, birth or breastfeeding. The same report states that in South Africa, approximately 40,000 children are infected with HIV each year, reflecting existing gaps in the PMTCT cascade.
At the April, 2011 UN High Level Meeting on HIV, the global community embraced a new commitment: A Global Plan to Eliminate Mothers-to-Child Transmission of HIV and Keep Mothers Alive. This Global Plan, headed by UNAIDS and USAID, has highlighted the role of Mentor Mothers as a key component in ensuring the success of PMTCT.
Since 2001, m2m has taken its Mentor Mother Model to scale, providing service in nearly 800 healthcare facilities (‘sites’) in nine African countries, and employing nearly 1,800 HIV-positive women on a full-time basis as Mentor Mothers. Across its nine country programs, m2m has found that although the majority of women do access antenatal and some PMTCT services at least once during pregnancy, many women are lost to follow-up at several critical points of care, resulting in missed opportunities during and after pregnancy to reduce the risk of mother to child transmission of HIV and promote maternal and newborn child health (MNCH). Some examples of these key services include CD4 testing, initiation of prophylactic or therapeutic ARVs, early infant diagnosis, uptake of family planning, and ongoing maternal and infant care. Drop-off or defaulting also contributes to a lack of opportunities to provide ongoing support and education on key topics, such as disclosure and infant feeding.
Like all health service delivery partners in resource-deprived settings, m2m collects basic client outcome data at site level in paper-based logbooks. Over time and with funding from a variety of partners including USAID, Johnson & Johnson and the Elton John AIDS Foundation, m2m has refined these paper-based systems in order to allow site staff some degree of accuracy in tracking clients, capturing data and supporting the delivery of interventions to improve client retention. These basic systems also allow us to measure short and longer-term performance outcomes with some degree of accuracy. Key challenges specific to PMTCT client retention, complicated by basic process and technology challenges, currently impede more accurate and timely data capture, analysis of that data, and tracking of client and baby health outcomes.
The key challenges are: an inability to systematically and at scale track longitudinal client attendance and key service uptake along the full ‘cascade’ of PMTCT interventions (complications rooted in intra-facility, inter-facility and cross-regional client migration); inability to measure accurate client retention, drop-offs and pain points in PMTCT cascade; and the need to collect and report on-site information on a more timely basis to inform program Quality Assurance (QA)/Quality Improvement (QI) efforts.
In order to enhance uptake of and retention in PMTCT and MNCH services, there is an urgent need for collection of longitudinal data, including cellphone numbers, from every woman attending antenatal (AN) and postnatal (PN) clinics. With successful development of the full set of data capture, abstraction, process, and reporting tools, by end of September 2012, mothers2mothers will be able to measure the outcomes of PMTCT (rate of HIV transmission from mothers to infants at 6 weeks-PCR Test and 18 months-rapid test), and achieve a better understanding of clients retention (retention distribution of priority services observed within the 18-month period), and associated pain points (distribution of causes for drop-outs within 18-month period) through each priority service point in the cascade.
Fast and easy access to this data would allow for individually targeted outreach and follow-up which can increase program effectiveness.
Through technical support from HP and Hyland Software Inc. (Hyland), m2m developed a web-based database, linked to the smart phones devices (cell phones with higher functionality) used at m2m’s clinical sites, to capture and store clients’ (mother-baby pairs) data centrally. m2m purposely ensured that the system did not store clients’ data on the smart phone devices to eliminate the risk of compromising confidentiality, loss and/or theft of clients’ data. Hyland Inc. continues to provide database maintenance and server balancing support to m2m in addition to the periodic software upgrades.
A key milestone in this project was achieved when m2m conducted its annual pre-service training for 101 Mentor Mothers on its Mother Baby Pair Tracking (MBPT) workflow processes, tools, and mobile-health solutions for clients’ data collection, and its reporting and management. During the MBPT pilot phase, m2m liaised with the Western Cape Province Department of Health (DoH) on the MBPT innovation. As m2m continues to work with the DoH and the U.S. Agency for International Development (USAID) mission in South Africa to institutionalize the Mentor Mother model into standard DoH PMTCT programming at national, provincial and district levels, MBPT continues to be a core component of the model. m2m has also established partnership with the MAMA (Mobile Alliance for Maternal Action) Project that is funded by USAID and Johnson & Johnson in South Africa. Like MBPT, the MAMA Project focuses on the use of mobile technology platform solutions for education and information sharing with pregnant women and new mothers. During the MAMA pilot development, select m2m Mentor Mothers assisted through participating in focus group discussions to improve on content and messaging for enhanced acceptability.
The MBPT has been integrated into the standard Mentor Mother program in 31 sites in South Africa and will continue beyond the time frame of this commitment with CGI.
SEEKING: Financial Resources, Implementing Partners, Best Practice Information, Media/Marketing Opportunities, Other
We are seeking funding, best practice information and effective and tested hardware and software tools that might help us to achieve the goals described in this commitment. Once the pilot phase is completed, we will need partners to support effective rollout including technology, implementation and staff trainings.
OFFERING: Financial Resources, Implementing Partners, Best Practice Information