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Projects

First HealthyBaby Birth

Mar 2nd, 2009
by melissa.
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The mother receives the baby from the nurses at the clinic.

The mother receives the baby from the nurses at the clinic.

As I have been pre-occupied with writing lectures for my class, and setting up my research, my collaborating partners at Marie Stopes International Uganda have been busy launching a new phase of the output-based aid voucher program, financing in-hospital delivery of babies, in addition to the in-clinic treatment of sexually-transmitted infections (STIs). The new program, called HealthyBaby is eligible to mothers who qualify under a specific poverty baseline and covers four antenatal visits, the delivery, and a postnatal visit. Last week they just started distributing vouchers, and this past weekend was the delivery of the first baby whose birth was covered by the program.

Like the HealthyLife program, the mother purchases a voucher for 3000 USh (approximately 1.50 USD, the HealthyLife program charges 3000USh for a pair of vouchers treating both sexual partners). The voucher then can be broken into several sticker stubs, one of which is submitted with a claim form on each visit.

The first mother puts her thumb print on the HealthyBaby claim form

The first mother puts her thumb print on the HealthyBaby claim form

The hospital then submits the claim form with the voucher to the funding agency (my collaborating organization), who then pays the hospital for the cost of the visit – labs, any prescriptions given, the consultation fee, etc. You can see in the picture to the right the nurse filling out the paper form and the mother putting her thumbprint on it. Filling out the forms can be tedious and error prone – this particular clinic had almost 18% of their STI claims rejected for errors last October. In the same month another clinics had 38.6% of their claims rejected. I am trying to work on digital systems that can help improve communications between the clinics and the funding agency, and also decrease the cost and burden of claims administration.

The Claim Mobile project actually focuses on the HealthyLife program – the STI treatment program, rather than the HealthyBaby program, but I hope to demonstrate the sustainability and replicability of the system that I’m developing by training the engineers here to retool my system for HealthyBaby – so by the time I leave, I am hoping it will be in place for both programs.

By coincidence, this first birth occurred in one of the two clinics where I’m running the pre-pilot of the Claim Mobile system.

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Netbook Mania

Jan 21st, 2009
by melissa.
10 comments

So one of the outcomes of my study last August is that admittedly.. people don’t want mobile phones for their health records, they want laptops. And these new netbooks – well they cost the same as these smartphones. But last August, the eeepcs had a battery life of 1.5 hours and only about 4MB of storage. So when they died in the middle of the comparative studies, all of the people I talked to changed their minds and said that battery life was a non-starter; they had to have something that would last. I did a little shopping though – and for just about $50 more, you can get a standard hard drive (instead of solid state), and a 6 cell battery, and end up with a 10in eeePC that lasts for 7 hours and has 160GB of hard drive space.

Even without the new configuration, people are raving about these netbooks. They won’t let me take them back to the states, and people keep buying them off me – so I have to replace them when I get back home, using the cash people give me. More stuff to carry when I come back – it’s a wonder I always make it through customs with my 6-8 laptops..

The reaction to my laptops this time is that everyone wants to buy these off of me “when your project ends” – to which I always say that when my project ends, the laptops will still be in use because the project will continue without me – unless they are already certain of my failure (I hope not!).

The proposal for now is twofold: two of the laptops will be used as asynchronous web servers, akin to the design used in the Ghana Consultation Network, allowing the Program Management Office in Mbarara and the Management Agency Head Office in Kampala to access claims information even when their Internet connection is down – basically, since the processor will certainly be slow, it will be a caching agent. (I might try Google Gears as well and see if that works better, but this is something that I can intelligently back up and that they can own locally.) The rest of the laptops will be allocated to two of the private health clinics for use in administering their claims forms. However – a primary distinction from the mobile phone solution is that they don’t include communications technology. I will explore a couple of options – including both a sneakernet style solution of sending the forms by SD card, or the more expensive solution of attaching a falcom modem to the laptop, which essentially doubles the cost of the laptop. A few other clinics will be assigned mobile phones, and the remaining clinics will be controls – I will visit them, continue to run surveys, and observe claims administration, and monitor their transcations, but I won’t deploy services there for at least the first 9 months, although I may encourage my partners to independent conduct their own deployment (i.e. with my supervision but not done by me) towards the end of my study.

This study involves simultaneously understanding both the technical feasibility of these solutions and the financial feasibility of these solutions – it will take time to make the service providers understand the ramifications of the various solutions – and the resultant costs and benefits to them. What are the tradeoffs they will make in the end? I think different providers will choose different means in the end.. and it is entirely possible that they might choose to purchase a laptop but not use it for online claims submission, purely for its other utilities. Or because the service provider is of higher means and higher claim volume, they might choose to do online claims submission and pay the service fees because timely payment is so extremely critical for them. I’m curious to see what happens, and I can’t wait to see how it all unfolds.

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Solar Power and Mbarara Update

Jun 12th, 2007
by melissa.
2 comments

It’s been a busy couple of weeks, with not nearly enough access to internet cafes!

This week I am back in Mbarara, currently using the computer science lab (which is empty because the students are all doing exams now), but also meeting with various professors here (again!) and working with Ben and Richard on the Smartphones for OBA project.

The major update is that we are now collaborating with the Faculty of Science at Mbarara (Physics Dept) to figure out solar power options for the health clinics participating in the OBA program. They are currently engaged in research evaluating the degradation of imported solar panels and are the perfect collaborators for this project. They also have experience with circuit-soldering, so they’ll try to use Manuel’s solar charge controllers both for their own experiments and our project.

We also visited the Marie Stopes International Uganda office and one of the Marie Stopes Uganda clinics. They are currently using the VMUS database developed by Microcare, and have two people entering the data from the (triplicate-carbon-copy) forms that are collected from the various clinics participating in the OBA program. Right now the system is down, so the forms are piling up, and they are entering the data into Excel, so they can process the reimbursements. I’ll head back there today or tomorrow to hammer on the SmartForm and figure out exactly what it should look like. At the clinic we spoke to Steven about his experience participating in the program. The major issues he identified are timeliness of reimbursement processing, limitations on the range of treatment options (if someone is diagnosed with a non-STI bacterial infection then they have to pay for treatment in addition to what they paid for the voucher, although I think the consult is covered), and patients coming in with vouchers that clearly don’t have an STI, and therefore are not eligible for subsidized treatment.  So there is a need for better and clearer marketing.  Richard suggested giving distributors placards that (literate) patients can read so they know what services the voucher will cover.  They also have problems with people going to multiple centers, and not having documentation for previous visits, or buying multiple vouchers and having tests done unnecessarily.   We hope that with the SmartForms project we’ll be able to address some of these issues, by making voucher records more accessible, and improving the communications process around the form submissions.  There’s lots of ideas flying around and a lot of work to do!

For the rest of the week (before I take off for Ghana) Richard and Ben and I will be visiting the various health clinics and talking to them about the project, getting a feel for their willingness/interest, as well as the environment in which the phones would be deployed.  We’ll start testing/piloting in August when I get back.

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Of Government Meetings and Snazzy Powerpoint Animations

Jun 9th, 2007
by melissa.
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The culmination of our many many meetings was our presentations to the Ministry of Health and the Member of Parliament (MP) for Nakaseke district.  (Although admittedly the MP meeting was a bit of a surprise, so a bit extemporaneous.)  We had been spending our evenings in Luwero (the town near Nakaseke where we were staying) processing everything we learned, and our days visiting the health centers.  We interviewed the in-charges, nursing assistants, and records officers/assistants at 3-4 health centers a day, and asked about stock management, health information reporting, and the general challenges they each faced in their daily work.  Almost none of the lower health centers (HCIIs and HCIIIs) had power (“We use lamps”), but even in the HCs with power the staff had mobile phones.  In those cases, they charge the phone by sending it off overnight with a matatu (the public mini-bus system) driver for the price of 500 shillings.  Most people have nokia candybars that stay charged for about 4 days.

I’m impressed overall with the staff we’ve talked to, and with how well all of the health centers comply with the Ministry of Health’s health information reporting policies.  They each submit weekly reports on highly infectious diseases (sometimes by SMS) as well as more comprehensive (4 page) monthly reports on stock levels, outpatient population, and diagnoses. In Rakai (another district) they submit these reports via PDA and gprs – here, they submit on paper in person to the district hospital in Nakaseke.

You can check out our findings in the presentation we made to the MoH, along with some ideas for integrating smartphones into their existing system.  The presentations (ours and that of the ICT team) were well received, and we are all looking forward to further collaboration on a project proposal, and hopefully a pilot once we receive funding to move forward.  There’s a lot of questions left to be answered (how do we balance paper and digital records? What about power?) and a lot of work to be done, but I have high hopes that handheld computing and communication devices like smartphones can make a positive impact on healthcare in Africa!

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