TITLE: Phones for Health: SMS for Blood Safety

NEED and COMPARATIVE ADNAVTAGE: Information technology companies have not been absent from

efforts to address HIV and AIDS in places like Sub-Saharan Africa. Participants in the first "Role of the

Technology Sector in the Global Response to HIV/AIDS" working session shared specific experiences in

using existing technologies to develop critical solutions to the capacity challenges in AIDS-affected

environments. Private sector information technology and telephone companies are an increasingly more

important component in addressing the HIV/AIDS epidemic globally. In order to increase data efficiency,

accuracy, and timely reporting, there has been a move toward automation of the data collection process,

and other blood service processes. This database helps the National Blood Transfusion Service (NBTS) to

collect and store important data for communicating and monitoring blood donor management processes.

Phones for Health will assist in telecommunications, serving as a recruitment tool for initial donors, a

reminder to return for repeat donors, a means for giving and receiving feedback, and a means for motivation

through subsidized SMS phone calls and generation of reports.

In FY 2007, the central database was established at headquarters and since its inception,

telecommunications have proven successful at linking the zonal system with NBTS headquarters. The

Eastern zone was the pilot experiment, and now logistics are in place to begin rolling out to the other 6

zonal centers. All of the data flows from the zonal centers to headquarters, which serves as a central point

for analysis and decision-making. Previously, the NBTS manually collected data and then transferred it to

the computer - a process that is slow, associated with transcription errors, and not amiable to broader

information coverage. In order to increase data efficiency, accuracy, and timely reporting, there has been a

positive shift toward automation of the data collection process, with the potential to apply automation

initiatives to other blood service processes. In FY 2008, this will be achieved by procurement of personal

digital assistants (PDAs), which will be used by data collection teams in all zones. Maintenance of the

information system, database review, and occasional upgrading procedures will be conducted though a

public-private-partnership working with Phones for Health to facilitate data collection, reporting, feedback,

and information transfer to repeating blood donors through subsidized mobile phone messages. All of the

information will be linked to the central computer database for convenience.

ACCOMPLISHMENTS: New activity

ACTIVITIES: In FY 2008, the NBTS plans to work with different cooperatives to establish and sustain ample

resources of repeated blood donors who voluntarily and regularly come forward to donate blood without any

remuneration. Activities include developing a mechanism for donor recall on regular and emergency bases,

formulating dialogue to motivate previous donors, re-invite lapse donors, and sustain donor clubs by

regularly keeping in touch with the implementing partner (NBTS) and advocating for blood donation as an

altruistic and healthy behavior.

Phones for Health will assist NBTS tele-recruitment by subsidizing charges for simple messaging systems

(SMS). Messages will be sent to non-remunerated voluntary repeated blood donor for the purpose of donor

recall. Other uses of the phones could include emergency donation calls or mass distribution of preventive,

and/or donor appreciation messages. Phones for Health may send messages on holidays or utilize

telecommunications to thank the donor for giving life. Phones for Health will sponsor some of the NBTS

advocacy messages through various media of communication (e.g., television, newspapers, and radios)

and could potentially assist in monitoring and evaluation initiatives by providing a medium for donor

feedback and reporting capability.

LINKAGES: Phones for Health will link with NBTS.

M&E: The activities will be monitored throughout the implementation of the program for expected outcome,

and impact to blood donor management system.

TITLE: Developing a mobile telephone system to support a warm line for strengthening post-training

mentoring for health care workers.

NEED and COMPARATIVE ADVANTAGE:

There is a need for follow up after trainings for health care workers. Health workers must travel long

distances to attend care and treatment training sessions at zonal training centers, and they rarely have the

benefit of structured guidance or refresher training once they return to their facilities.

Current trainings in care and treatment for HIV/AIDS and prevention of mother to child transmission have

shown that follow up for participants is required to ensure that the training is effective. Follow up can be

performed through multiple facets, including establishing a warm line where participants can call the trainers

or designated experts to ask questions or confirm treatment plans. One such warm line has been

established in Tanzania at Kilimanjaro Christian Medical Centre on a small scale.

The Phones for Health Initiative (P4H), which brings mobile phone operators in a public-private partnership,

have the ability to establish a toll-free number that would be used to establish a warm line. I-TECH, which

is supporting in-service training and has expertise in operating a warm line, will work with P4H to establish it

on a larger scale in Tanzania.

ACCOMPLISHMENTS:

Not applicable, new partner in this area

ACTIVITIES:

1) Establish an agreement with mobile phone operators in Tanzania (e.g., Celtel, Vodacom, Zantel)

The Phones for Health Initiative has a partnership with the mobile phone operators in Tanzania to establish

a toll free number that can be used by health workers to ask questions about treatment and care plans. The

toll free number will be linked to warm line operated by clinicians and medical officers who are master

trainers or experts in HIV/AIDS care and treatment.

The framework for the toll free line will be developed by ITECH who is guiding the development of the

curriculum for in-service and pre-service training conducted at zonal training centers. The current national

HIV training consists of a 6-day course with a 3-day practicum. Working closely with the Ministry of Health, I

-TECH will develop the framework for operating a warm line while P4H will establish the toll free number

and train health workers how to access it, using the current training opportunities.

2) Monitor and track the use of the warm line to strengthen and support health workers at the facility level.

The remote location of many health facilities in Tanzania is a significant barrier to the Ministry's efforts to

supervise, mentor and support health workers in the field. While most facilities lack Internet connectivity, the

majority now have access to a mobile network. Phones for Health and ITECH will leverage this network to

provide support to recently-trained health workers through a warm line. P4H will monitor and track the use

of the warm line to evaluate its use and changes that may need to occur. In addition, using the toll free

number, regular care and treatment reminders and tips can be shared with training participants via SMS.

ITECH would develop the content, sequence and frequency of the messages drawing on the national care

and treatment curriculum, while Phones for Health would work with the mobile phone operators to broadcast

the messages to health workers who had recently participated in trainings.

LINKAGES:

This activity links with the MOH and NACP to coordinate training activities and to ensure the program is

implemented according to their mission. It also links with I-TECH

CHECK BOXES:

Phones for Health Initiative, which seeks to strengthen information exchange through the use mobile

phones. The retention strategy is to continue support for health workers to provide services after trainings.

TITLE: Phones for Health Initiative in Tanzania

NEED and COMPARATIVE ADVANTAGE: The Government of Tanzania (GoT) is committed to

strengthening its response to the HIV epidemic. To do this effectively, it is crucial is have information

systems that produce reliable, timely information for all HIV program activities in order to make informed

decisions and affect policy and guideline changes. These HIV programs include prevention of mother-to-

child transmission (PMTCT), antiretroviral treatment (ART), TB/HIV, malaria, facility and community-based

palliative care, and care for orphans and vulnerable children (OVC).

In FY 2008, Tanzania will strengthen national HIV/AIDS strategic information capacity through participation

in the Phones for Health public-private partnership. Phones for Health will leverage human, financial and

physical resources from its partners - including OGAC, the GSM Association Development Fund, Accenture

Development Partners, Motorola, MTN and Voxiva - to establish a sustainable national information system

for HIV/AIDS and related diseases in Tanzania. The Phones for Health model builds on local

telecommunications infrastructure and utilizes multiple user interfaces, allowing workers at health facilities

to record and report monthly and quarterly data, as well as national-level indicators locally and transmit data

to regional and central-level program managers by phone or computer. The system will work along-side

traditional means of reporting data. The system also provides multiple channels for communication and

feedback between levels of the health care system. The Phones for Health architecture consists of a series

of core modules, each of which supports a key care and treatment function, such as patient registration,

communication between facilities and central authorities, and program indicators reporting. GoT is

committed to advancing national strategic information capacity and will devote substantial staff and

resources to the oversight of data collection, quality assurance and training in support of this activity.

ACCOMPLISHMENTS: An outreach and advocacy visit with the Phones For Health consortium was

conducted in July 2007 to meet with GoT stakeholder and implementing partners. So although this is a new

activity for Tanzania, Phones for Health builds off its successes in Rwanda with a similar system, which is

now expanding to include other areas of HIV/AIDS reporting and monitoring and serves as a major resource

for the health sector.

ACTIVITIES: In-country staff initially planned for Phones For Health before the 10-county initiative was

announced, which resulted in a delay of some activities planned for FY 2007. For FY 2008, activities can

move quickly towards activities outlined.

1) Outreach and Needs Assessment: A Phones for Health team will meet with key stakeholders in

Tanzania, including Ministry of Health (MOH) representatives the National AIDS Control Program (NACP),

the Tanzania Commission for AIDS (TACAIDS), and USG to document Tanzania's HIV/AIDS information

needs and how Phones for Health will address those needs. In collaboration with these stakeholders, the

team will conduct a rapid assessment including: stakeholder analysis, health system mapping, resource

capacity assessment (i.e. both number of people and capacity to conduct activities), baseline information

gathering, work flow analysis, and review of existing HMIS. Accenture Development Partners and Voxiva

will jointly lead this activity, which will be funded centrally by OGAC and GSMA.

2) Planning and Requirements Gathering: The Phones for Health team will work closely with MOH, USG

and other donors to determine how the system will be customized to support Tanzania's health operations.

This will involve defining custom modules, user roles, governance and management structures, business

practices and work flows. USG will also collaborate with initiating Phones For Health countries for cost-

sharing, as this activity is likely to be similar across, considering similar reporting structures. The roles and

contributions of participating Phones for Health consortium members will also be defined and documented,

and a phased implementation plan and budget, including ongoing communications and support, will be put

in place. Once these items are agreed upon, Voxiva will gather system requirements, such as language

options and user permission levels. The NACP will provide essential information like national ARV drug

regimens, facility profiles and locations, and HIV program indicators.

3) System adaptation and configuration: Voxiva and other consortium members will work with MOH, NACP

and USG technical staff to adapt the Phones for Health system to Tanzania's administrative divisions,

health reporting hierarchy, management structure, HIV/AIDS services and program indicators and monthly

and quarterly reporting requirements. For example, user roles will be created to control which types of data

are accessible to different users of the system, such as national HIV/AIDS program managers, district

health officers, facility-based health workers, USG agencies and implementing partners. Each user will then

be assigned a user role that is linked to the appropriate facility identification numbers and to a unique user

ID and password.

4) Phase One Deployment: Voxiva's experience implementing TRACnet in Rwanda has demonstrated that

it is possible to achieve nationwide deployment of the Phones for Health system in a relatively short period

of time, though it is anticipated that deployment will take longer in larger countries. In FY 2008, Phones for

Health will be initially piloted in national, regional and referral hospitals, with the expectation that national

deployment will be achieved by Year 2 of the project. Motorola will provide subsidized GPRS-enabled

phones loaded with J2ME software (donated by Voxiva) to support rapid implementation and expansion.

And with continued discussion, an in-country mobile phone provider, yet to be determined, may provide

subsidized hosting, software maintenance and support services on an ongoing basis.

LINKAGES: This activity links closely with TACAIDS, the Ministry of Health and Social Welfare (MOHSW)

and the National AIDS Control Program, which are the true proprietors of the health sector reporting

activities. There are also linkages that USG-Tanzania will maintain with OGAC and with other countries

implementing similar activities with other members of the Phones for Health consortium. This is necessary

for cost-sharing and activity- sharing as activities are planned and expanded.

CHECK BOXES: This activity is a national information system for data collection and reporting.

M&E: The Phones for Health team will adapt its role-based training curriculum to the logistical and linguistic

needs of Tanzania. All users, including MOHSW, NACP and TACAIDS, and health care workers, will

receive training in modes of data entry and transmission, data retrieval and display options (including

customization of reports and data dashboards), feedback and alert mechanisms, and security features. The

team will also self-monitor and report on its activities to USG and GoT for continual updates and program

Activity Narrative: implementation flow.

SUSTAINAIBLITY: Sustainable staffing and local capacity building (both human and institutional) are critical

to the success of Phones for Health in Tanzania. The Phones for Health team will recruit a full-time

technical advisor to provide long-term training and technical assistance to the local management unit, which

will be located within the MOH/Health Information and Research Section, Health Management Information

Systems (HMIS) Unit. The local management unit will be responsible for system administration, ongoing

training of Phones for Health users, analysis and dissemination of Phones for Health program data, and

feedback to districts and facilities on data quality and performance. Accenture/GSMA will provide medium-

term technical assistance in the form of in-country consultants with specialized knowledge in HMIS,

planning and project management. Together, the technical advisor and Accenture/GSMA consultants will

support the local management unit in these functions for the first 18-24 months of deployment, with the goal

of transferring the knowledge and skills necessary for day-to-day management of the system to the

management unit in the second year of deployment.