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Interoperability & Crowdsourcing: Can these improve the management of ANC programs?


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Webinar presentation by MEASURE Evaluation SIFSA's Joy Kamunyori and Rob Allen

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Interoperability & Crowdsourcing: Can these improve the management of ANC programs?

  1. 1. Interoperability & Crowdsourcing : Cantheseimprove themanagement of ANCprograms? Joy Kamunyori MEASURE Evaluation, SIFSA Rob Allen MEASURE Evaluation, SIFSA January 19, 2016 The MomConnect Project
  2. 2. Presentation • Discuss how MomConnect is improving access, coverage, and quality ofANC for women in SouthAfrica. • Discuss how data system interoperability and crowdsourcing are improving information systems and access to data for improved data- informed decision making.
  3. 3. Key theme − interoperability Integration of data systems: “. . the property that allows for the unrestricted sharing of resources between different systems. This can refer to the ability to share data between different components or machines, both via software and hardware, or it can be defined as the exchange of information and resources between different computers through local area networks (LANs) or wide area networks (WANs). Broadly speaking, interoperability is the ability of two or more components or systems to exchange information and to use the information that has been exchanged.”
  4. 4. Key theme − crowdsourcing Crowdsourcing: “… an online, distributed problem- solving and production model that leverages the collective intelligence of online communities for specific purposes.” “…an approach to accomplishing a task by opening it up to broad sections of the public. Innovation tournaments, paying online participants for categorizing images and seeking feedback from a specific target group are examples of crowdsourcing. What ties these approaches together is that the task/request is outsourced with little restriction on who might participate.”
  5. 5. MomConnect • SouthAfrican National Department of Health (NDOH) initiative • To support maternal health through the use of cell phone-based technologies • Overall aims: 1. Introducemechanismforrecording allpregnanciesinthepublichealth systemasearlyaspossible 2. Enablesendingoftargetedhealth promotionmessagestopregnant women 3. Providepregnantwomenwith mechanismtoprovidefeedback– Effectively crowdsourcing information
  6. 6. Why cell phones? • Successfully used to improve MCH outcomes by multiple projects in several countries • High levels of cell phone access • Potential to accelerate the proven value
  7. 7. MomConnect • Launched on 21stAugust, 2014 at KT Motubatse Clinic, Soshanguve in the Tshwane District of Gauteng Province • Launched by Minister of Health and partners, including the US Ambassador representing the President's Emergency Plan for AIDS Relief (PEPFAR) programme • Over 500,000 women registered in first year
  8. 8. MomConnect registration process
  9. 9. How does it work?
  10. 10. MomConnect registration information • Data points collected: o Phonenumber—automatically collectedifusingownphone;manuallyentered ifusinghealthcareworker’sphone o Preferredfacilitycode—nationally approved6digitcodethatisusedto uniquelyidentifyahealthfacility o Estimatedduedate o IDnumber(orpassportnumber)—intheeventofnoIDorpassportbeing available theusermustentertheirdateofbirth o Preferredlanguage—outof11officiallanguages Collected via USSD
  11. 11. What is USSD? Unstructured Supplementary Service Data
  12. 12. Why USSD?
  13. 13. Interoperability • Designed to be interoperable with other systems o HasbeendesignedtobecompliantwiththeSouthAfricanHealthNormative StandardsFrameworkforeHealth(HNSF)andthecountry’seHealth architecture • Information collected sent to a health information exchange and stored o Incomingmonthswill belinkedwiththeNationalPatientMasterIndex o Linkageswithothersystemsbeingactivelyexplorede.g.,TIER.Net(HIV informationdatabase),NationalHealthLaboratoriesSystem(NHLS)
  14. 14. Data use for MomConnect • MomConnect data is already being used to improve the health system • There are also a number of potential uses of the data and the system in the future • Interoperability is key in increasing the potential for effective data use
  15. 15. Current usage of data from MomConnect • Setting targets for numbers of women registering • Monitoring registrations by pregnant women against targets and identifying at which clinics and district improvements are needed • Improving service delivery at facilities • Individual client care
  16. 16. Helpdesk • There is a helpdesk which handles compliments and complaints as well as frequently asked questions • Registered MomConnect users can send a compliment or a complaint about services they have received directly to the national helpdesk via SMS • There have been approximately 6 times as many compliments as complaints
  17. 17. Complaints • Complaints are sent directly to MomConnect focal points in each of the 52 districts in South Africa. These people have the responsibility to follow up and provide a response on how the complaints will be resolved within 10 days • If no response or resolution plan is received within 10 days then there is a rapid escalation procedure
  18. 18. Examples of complaints and resolutions • Complaint: Lack of iron supplements in clinics was reported by multiple users o Resolution: The process for supply of iron tablets was investigated and problems identified and resolved. This can be verified by no new complaints forthcoming about supply of iron tablets. • Complaint: Long waiting times and lack of information on when patient will be seen o Resolution: The processes in the clinics was investigated and commitments made to improve processes communication to service users.
  19. 19. Service ratings survey • After a pregnant woman is registered on MomConnect, her information is securely stored on a central server. The day after the registration, the woman is sent an SMS which asks her to rate her service at the clinic by using the service rating code of *134*550*4#. • In the first six months of operation approx. 10 percent of women registering at clinics filled in the service rating survey.Asecond follow-up message was added and now over 25 percent of women registering at clinics filled in the service rating survey. • 78,916 service ratings were received between 1 Oct 2014 and 30 Sept 2015.
  20. 20. Survey design • The survey was based upon questions that it was felt that pregnant women could reasonable answer about their experience at the antenatal clinic and was aligned to the NDoH’s “Towards Quality Care for Patients: FastTrack to Quality: The Six Most CriticalAreas for Patient-Cantered Care” document. This covered whether: o staff were friendly and helpful o privacy was respected by staff o waiting times were acceptable o the facility was clean • It was also determined that it would be useful to get a quantitative indicator of actual waiting times.
  21. 21. Service rating survey example questions • Afive-question service rating survey was programmed and linked to the service rating code. When a woman dials the service rating code, these questions are asked in sequence: • Example questions o Q2. How do you feel about the time you had to wait at the facility?  Very Satisfied |Satisfied |Not Satisfied |Very Unsatisfied o Q3. How long did you wait to be helped at the clinic?  Less than an hour |Between 1 and 3 hours | More than 4 hours |Allday
  22. 22. Reporting on service ratings • The collected data is automatically uploaded to a reporting system (DHIS 2).This allows for real time data and dashboards • Standard service rating reports have been developed for calendar months and calendar years for provinces, districts, subdistricts, and facilities. These reports attach the following data to service ratings for the purpose of comparison: o First antenatal visits asper the SouthAfrican DHIS data set for the previous year o Aggregated MomConnect registrations during the time period specified o Aggregated number of service ratings for the time period o Rating response rate (a percentage based upon the formula: number service ratings / number of MomConnect registrations)
  23. 23. Reporting (2) • The total number of survey responses per answer are given inadditional columns together with percentages • This allows for comparison between facilities (and provinces and districts) regardless of the total number of service ratings received Facility X Aformulaisusedtoprovideascoreoutof100.If everyoneisveryunsatisfiedthenthescorewillbe0–If everyoneisverysatisfiedthenthescorewillbe100
  24. 24. Service rating data: Upward trend (Hawthorne Effect?) 65.00 70.00 75.00 80.00 85.00 90.00 Jan-00 Jan-00 Jan-00 Jan-00 Jan-00 Jan-00 Jan-00 Jan-00 Jan-00 Jan-00 Jan-00 Jan-00 Cleanliness Rating Friendliness Rating Privacy Rating
  25. 25. Opportunities for improved feedback to districts and facilities • All service ratings can potentially be given to districts and facilities to enable management to address reported issues. • It may even be appropriate for any “Very Unsatisfied” response to be treated as a complaint about the services at the specific facility and followed up accordingly. • The actual scores may give an impression that all is well if a facility has an overall score of 65 out of 100. However, this is much lower than average and can be highlighted as such.
  26. 26. Service rating survey challenges • Theservice ratingcomponentofMomConnectis affectedbythe same issuesaffectingregistrationofwomenon MomConnect– networkand languageissue. • As ofAugust2015,only78.4percentofuserswhostarted thesurvey ratingssurvey completedit. • It tookan averageof 1.6 usersessionsto completethe survey.This impliesthatmanyusersexperiencetime outsduringthesurvey. • Anotherissue isthatthere maybe somebiasin the responsesdueto self-selectionbysurveyparticipantsandnonresponse.It maybethat womenwith a strong positive or negativeviews aremorelikelyto completethe survey thanthose with nostrongopinion. • Thepositioningof theanswersmayalsoaffect theratingsin thatsurvey, asrespondentsmayjustchosethe first optionor maynotsee the last option.Both of theseissueswarrantfurtherstudyastheymayaffectthe qualityof the surveydata.
  27. 27. Possible future uses of the current data collected through the MomConnect System • Data about the length of pregnancy at first visit can be used to identify where interventions are required to get women intoANC before 20 weeks. • The data around the pregnant women’s ages and estimated due date can be used to provide information for policy makers. • The data around language choice per district can be used to inform health promotion programmes per district.
  28. 28. Possible future uses of the system • The service rating survey model can be used at other times – for example getting feedback from women about their experiences during labour or main problems faced during the first few months of motherhood. • The compliments and complaints model can be used throughout the health system (not just antenatal clinics) to provide a means of providing a voice to citizens. • The system can become the backbone of a longitude record of care for the child (an enhancement of the Road to Health card given to each child) which could record information such as vaccinations, PCR test information, illnesses, allergies, etc.This could feed into a standardised electronic patient record.
  29. 29. Final points • Crowdsourcingdatafrom service beneficiariescan bean effective tool to generatedatato supportthe implementationofpatient-orientedservices. • UsingUSSD andSMStechnologiesfor datacollectionhasadvantages over traditionaldatacollectionmethodsbecauseit enablestheDoHto collectdataon a nationalscale. • Theimmediatevisual displayofdata into dashboardshelpsmanagerto quicklyidentifyandsolve problemsto improveservices. • It is possiblethat theact ofmonitoringishaving a positive impacton services asratingshave increasedover the first yearof the MomConnect implement.However,thereareotherfactors whichmayhave hadan impact. • By makingdata systemsinteroperable,standardizingmaster facility lists, andstrengtheningthe nationalpatientmasterindex,the nationalhealth informationsystem is beingstrengthened.Thisresultsin greateraccessto dataandimproveddata-informeddecisionmaking.
  30. 30. MEASURE Evaluation SIFSA is implemented by the Carolina Population Center at the University of North Carolina at Chapel Hill in partnership with John Snow, Inc., ICF International, Management Sciences for Health, Palladium, and Tulane University. For more information, visit and This presentation has been supported by the United States Agency for International Development (USAID) under the terms of MEASURE Evaluation – Strategic Information for South Africa associate award AID-674-LA-13-00005. Views expressed are not necessarily those of USAID or the United States government.