Critical Thinking

It but not limited to: Preventive health; Environmental

It is
common to find in most health facilities in Ghana computing equipment, servers,
imaging and printing system, databases, communication and Internet service
systems running independent of each other. The existing information system
infrastructure of these facilities are not integrated, thus operate as
independent monolithic silos, denying the entire infrastructure the benefit of
data sharing, concurrency, distribution, and fault tolerance. When systems are integrated,
it guarantees heterogeneous fusion of independent silos which provides a common
platform for applications with different access procedures, data formats and
protocols to share resources and communicate effectively. A number of these
health facilities are not networked in a way that supports quality healthcare
practice internally or externally. Even at facilities where local area network
(LAN) infrastructure exists, it has been reduced to only surfing the web or
operations at the front office. In situations where a health facility’s LAN infrastructure
is said to be utilized, then it is assisting in the provision of the following;
registration and record keeping of patients at the OPD, keeping track of
supplies at stores, automation of pharmaceutical services, managing consultations
and review of reminders. “There is currently no operational e-health
architecture for medical system provision in Ghana.” (National E-Health
Strategy, 2010, p.27).

The only
integrated national health system for health data reporting is the District
Health Information System (DHIS). The DHIS has been designed and deployed for
capturing routine data, a quarterly TB data and a client satisfactory survey
data at the district level. 

The
ministry of health (MOH) is developing an E-health application and hope to deploy
it all over the country when completed with the aim of providing patients,
health practitioners, researchers and students, with requisite access to health
related information based on need to know. 

The
government is in collaboration with association of mission health institutions,
quasi government institutions, private health institution, and non-governmental
organizations to develop the framework and institutionalization of the
infrastructure. The platform is expected to deliver all types of health
information, including but not limited to: Preventive health; Environmental Sanitation;
Maternal and Reproductive health; Child health; Malaria; HIV/AIDS;
Tuberculosis; Nutrition; Youth health issues; Insurance Issues; Traditional
Medicine; Drug Information. This delay with a national health infrastructure
notwithstanding, a couple of mobile health interventions are currently ongoing
in various parts of the country to augment the effort of the Ghana Health Service
in expanding access to healthcare.

 

             The past few years has seen the use of mobile
platforms in Ghana for a variety of purposes, ranging from personal
communication to health Information technology infrastructure. The application
of mobile technology in health has been increasing steadily in Ghana. There are
several ongoing projects in the health sector sponsored by private and
non-governmental organization where mobile devices are used for activities such
as: data gathering, disease surveillance, facility supervision, and drug
adherence promotion.  Others activities
performed using the mobile devices are immunization and antenatal/ postnatal follow-ups,
and health facilities stocks monitoring.  

The common
mobile devices that are used for these activities include smart phones, pocket
digital assistants and simple cell phones. The earlier phones that were used
for these activities were simple cell phones and could only access calls and
SMS messages. At the time the services provided by mobile telecom service
providers could not support internet access, video calls and mobile TV. With
the recent introduction of 3rd Generational (3G) Network technology by the
network companies, a myriad of digital devices with 3G compliant platforms are
those that are used for health data collection, analysis, and
dissemination.  

 

Currently
there are six mHealth projects ongoing in Ghana for different aspects of health
delivery. They are Motech, SMS for Life, EWS, Sene, Millennium development and
USAID Deliver mHealth project.    

 

1.5.1.1           Mobile Technology for Health
(MOTECH)  

MOTECH is
an initiative of the Ghana Health Service and the Grameen Foundation, Columbia
University’s Mailman School of Public Health. 
It was funded by the Bill and Melinda Gates foundation. 

 

The aim of
the project is to improve the quality of data collection on antenatal and
neonatal care provided by community health attendants in the rural areas by the
use of available mobile devices. 

The MOTECH
program is in two forms, one for expectant and new mothers, and the other for
nurses to manage patients’ data. MOTECH has also developed another running
program known as the Mobile Midwife. The Mobile Midwife Initiative is an
innovative program which provides expecting or new mothers with accurate
maternal health education and reminders in the form of text or voice messages
for upcoming clinic checkups for themselves or their babies. The nursing
component enables direct entry of patient visits and review information onto
the mobile phones of the nurses. The nurses use this information in generating
accurate monthly reports which improves their efficiency and saves time.  

MOTECH uses
a Java 2 Platform Micro Edition as the software for data capture and storage.
The data when gathered is then transmitted by the help of a GPRS to a
centralized server operated by MOTECH. On the server is an electronic medical
records management system that analyzes the data against proper care procedure
and also determines dates for review visits. Monthly reports can also be
generated from the data submitted by individual nurses (Grameen Foundation,
2010). MOTECH currently operates in four regions in Ghana, namely; Greater
Accra, Central, Volta, and Upper East. It has about 66,000 registrants, being
mainly expectant and new mothers and 40, 000 mobile midwife enrollees on its
platform (MOTECH, n.d). 

 

1.5.1.2           Sene District PDA Project 

 In the 2004, the Berekum Health Directorate in
collaboration with Access to Health, an NGO based in the United States of
America launched what is currently known as the Sene District PDA project. The
Sene District PDA project uses pocket digital assistance to improve service
delivery at the lowest level of health delivery. It the foremost mobile health
project in the Ghana Health Service to assist practitioners in the Community
Based Health Planning and Services (CHIPS) compounds, which is at the lowest
level of health service delivery in Ghana (Access to Health, 2009). 

.   

Objectives
of the project are: 

 

a.         To generate reports that is accurate
and timely for effective decision making by the community health officers and
the district health management team. 

b.         To use emerging and appropriate mobile
technology available to reduce the time Health 

Officers
spend to generate monthly report on services they provide to the communities. 

c.         To improve the follow up of children
and mothers for certain health services. 

d.         To reduce the rate at which mothers and
children drop- out for immunization and safe motherhood services
respectively. 

The
clients’ data are collected with the use of a PDA device running on a java
platform. 

 

1.5.1.3                   Millennium Village
Project 

The
Millennium Village project in Ghana is a mHealth project which is being
implemented in Amansie West District in the Ashanti Region.  

Villages
that benefit from the project are selected by development agencies to receive
assistance in reaching the Millennium Development Goals and transforming the
lives of over 30,000 inhabitants out of poverty. 

Bonsaaso is
one of the towns that has benefited from this assistance and since 2006,
Bonsaaso’s schools and health clinics have seen major improvement  in the area of new school buildings,
rehabilitation of old facilities, and the supply of medical equipment and
services  to community. 

There was
also a provision of an ambulance service facility by the development partners
to Tonto Krom, a neighboring town, about 12 km to the nearest district
hospital. 

 

Despite the
provision of ambulance service to the community, maternal deaths in the
community did not reduce, because there was not any effective means of
communication between the locals and the health facilities for timely medical
assistance to be provided in the event of an emergency.   

Mobile
phone manufacture, Ericson and Ghanaian Telecommunications service provider,
Zain, developed an IT solution to the communication problem in 2006. This they
did by making internet service available to the villages and also providing
them with low cost mobile handset. This facility was to enable the locals to
overcome their communication nightmares and to establish reliable and cost
effective contact to health services providers, when the need arises. The
health services providers were given free handsets while the locals were
charged US$10 for each.   

 

In the
event of an emergency, the locals call the help line at the health facility,
and the ambulance is quickly dispatched to the location to bring the patient to
the hospital. A bed is then prepared in advance to receive the patient. 

 

Since the
introduction of these combine interventions in Bonsaaso, the UN says maternal
health indicators have improved and this they say is a result of improved
primary healthcare services. It is evidently clear that this success can
largely be attributed to the telecommunication solution which gave the locals
the ability to report cases in time for the appropriate intervention to be
received (Millennium Village Project, 2009).  

 

 

 

1.5.1.4    USAID-Deliver Project 

The USAID
Deliver Project in collaboration with the President’s Malaria Initiative and
the 

National
Malaria Control Program developed a project which aimed at using a software to
collect data and generate quarterly reports on malaria logistics that are sent
to the regions. This project is achieved through the use of Episurveyor; a
mobile phone survey software with functionalities which allows for efficient data
collection and analysis (USAID|DELIVER Project Bulletin, 2009).   

This
project has been ongoing since July 2009.  

 

1.5.1.5    Early
Warning System 

The Early
Warning System is a USAID sponsored project which is being piloted in three
regions namely; Greater Accra, Western and Central. This pilot is currently
taking place in six district from the three regions mentioned, with the purpose
of using mobile phones to collect data on health commodities from the districts
and send SMS to a centralized logistics management system. The Early Warning
System (EWS) facilitates data collection from service points through an SMS
message from facility workers’ personal mobile phones. The messages are then
forwarded to a toll-free short code registered with each of the mobile service
providers in the country. These messages are finally routed to the central
local server for analysis and appropriate intervention. 

 

The main
objectives of the Early Warning System are to provide near real-time
information on status of health commodities that are provided by service
providers to decision-makers at all levels of the service structure and
reinforce the availability of all essential health commodities by improving the
timeliness and accuracy of paper-based ordering and reporting from the lower
level of service provision. 

 

The system
is design to involve the regional medical stores, district directorates and
health facilities, to ensure better coordination among the various levels of
health commodity distribution.  

The system
will also enable managers of the system to accurately calculate the facilities
monthly stock and average monthly consumption and stock status. 

The system
as an inbuilt reorder level flag which automatically triggers an effect and
sends an SMS message to the district, regional, and national pharmaceutical
stores in that order for supply to carried out.  

 

 

 

1.5.1.6    SMS
for Life Logistic Management  

This
project is yet to be implemented in Ghana. It is similar to USAID Deliver
project. It will be implemented as a pilot project in six districts in three
regions, Brong Ahafo, Upper East, and Greater Accra Region. The aim of SMS for
Life project is to provide visibility of anti-malarial stock levels to support
more efficient and reliable stock management using available SMS technology,
using a public, private partnership model that works effectively. The SMS for
Life project is believed to have the potential to alleviate restricted
availability of anti-malarial drugs or other medicines in rural or
under-resourced areas (Barrington, Wereko-Brobby, Ward, 

Mwafongo,
and Kungulwe, 2010). 

 

These
projects show that mobile devices can be used for the following: 

a.         Health service delivery.  

b.         Epidemic monitoring and disease
surveillance   

c.         Ensuring follow-ups and minimizing
drop-out rate  

d.         Report generation. 

 

All these
six above projects are geared toward the attainment of the millennium
development goals on health which are listed below. 

MDG 4:
Reduce child mortality: Reduce by two-thirds, between 1990 and 2015, the under-
five mortality. 

 

MDG 5:
Improve maternal health: Reduce by three-quarters, between 1990 and 2015, the
maternal mortality ratio. 

 

MDG 6:
Combat HIV/AIDS, malaria, and other diseases: Have halted by 2015 and begun to
reverse the spread of HIV/AIDS; have halted by 2015 and begun to reverse the
incidence of malaria and other major diseases (Ghana Health Service,
2011).  

The MOTECH
platform will be used for this study.  

 

1.5.2.
Ghana E-Health Strategy 

Since
mHealth technology is believed to provide opportunities for individuals,
healthcare practitioners and providers to access information and share with
relevant service points thereby offering efficient healthcare support to the
citizenry, the Ghana E-Health Strategy outlines a number of benefits that it
seeks to achieve through comprehensive eHealth architecture. The benefits are
as follows: 

•           Improved accessibility and
availability of quality healthcare services to underserved communities through resource
sharing among primary, secondary and tertiary healthcare providers 

•           Improved quality of care and
treatment by reducing the queuing time for patients to receive care and
response time for medical practitioners to offer care. This positively affects
the health outcome of the patient. 

•           Improved monitoring of stocks and
supplies of medical and non-medical item due to an enhanced integration of
stakeholder systems within the supplier chain.  

•           Provides a platform for eLearning to
be done from remote locations, thereby promoting continuous academic
development. 

•           Improved credibility in the
gathering, interpretation and dissemination of data for both healthcare and
non-healthcare decision making.   

 

1.5.3.
Prospects of mHealth

The role of
mHealth in disease management and access to care provision cannot be over
emphasized.  Mobile devices with inbuilt
geographic positioning components, can serve as tools to enable the location of
patients in emergency situation. MHealth systems can also assist in epidemic
monitoring and disease surveillance. 
MHealth platforms can also be used to monitor and assist clients with
chronic diseases and facilitate medication adherence.  Managers can also use mHealth tools to
improve monitoring, coordination and assessing feedbacks as well as improve on
the efficiency of the health facilities. MHealth systems can also facilitate
financial accountability on the part of managers and cost reduction of services
delivered to patients.

 

The
effectiveness of any of these devices in improving  the health status of patients and meeting the
goals of service providers is a function of the type of application, the target
population, and the type of care rendered (Gagnon et al., 2005; Whetton,
2005).