I’ve just come back from a 10 day visit back to Ethiopia, spending a week back in Mekelle visiting our phd students’ projects and a few days in Addis following up some contacts there for future project development.
Case Management Tools for HEWs
We spent a couple of days with the Health Extension Workers and midwives who are using the maternal care protocols and scorecard:
- We introduced them to the HEAT mobile application we have been working on recently. Their feedback this was really positive. They liked being able to access the videos directly on their mobiles.
- One of our concerns was that they’d have trouble with the content and quizzes all being in English, but actually what the HEWs told us was that they liked it being in English, since the entrance exam for the HEAT programme will be in English, so having the self assessment questions in English is actually good practice for them. Although the real test will be if we see them continuing to use use it.
- They seemed to like the changes that we’ve recently introduced to the protocol forms and appreciate that the changes we are making are based on their suggestions for improvements. They seem keen to see us using the same system for other aspects of their work, for example IMCI (Integrated Management of Childhood Illnesses), tuberculosis, immunisations and others.
- The HEWs really like the mobiles and seem to have very few problems using them. In fact several have managed to create their own facebook accounts, even though we have never mentioned anything about this, plus other general internet access.
- Something we noticed was that many HEWs were not using the rubber protective covers for the phones, or the bags we provided. Apparently the rubber covers make it difficult to fit the phone in their pockets, and the bags are too small to hold the other items they need to carry for work. So we need to rethink what we provide them to help protect the phones. We’re thinking about getting the TVET college in Wukro to make some leather bags for us. They made the tables for our elearning labs at Mekelle Uni, so we just need to find a good bag design for them to create a sample for us.
- Solar lamps/chargers – originally we had given the HEWs a d.light to use to recharge the phones and for lighting. As a trial, we also bought one ST2 solar lamp/charger from the Solar Energy Foundation office in Addis. It seems only a few HEWs use the solar chargers for recharging their phones, most, even though they don’t have electricity supply at their Health Posts, charge their phones at home or elsewhere in the local town. For those who are using the solar lamps/chargers, they felt the one from ST2 was better as the battery lasted longer, and fully charged the phone. This works well for us since these devices are available in-country whereas the d.lights we would need to import. The cost for each type of device is roughly similar.
A couple of other observations/notes:
- Phone reliability. So far, after almost a year of usage, we have had a much lower level of phone breakage or loss that we originally expected. Our initial expectation was that we may need to replace around 25% of the phones per year. However, so far we have had no phones lost or stolen. The only hardware issue we’ve had so far is with some phones having insensitive touch screens. 3 of the 20 phones we initially bought have got insensitive screens, although 2 of these had insensitive screens when we initially bought them. We have some replacement screen kits, so we’ll try to fix these. We’re very pleased with this low level of breakage/loss, especially since we are using second-hand phones bought on eBay.
- We also need to start looking at which phone models may be a good replacement for the HTC Hero phones. Although the HTC Hero phones have been working well for us so far, they are a relatively old phone model, and their availability is likely to decrease, so soon we’ll start to look at which phones may make a good replacement model, based on cost/performance and availability. The only Android phones which seem to locally available are high end Samsung Phones, priced at almost 14,000 birr (approx 640 Euros) they are a little expensive!
- We heard that one of the local phone manufacturers may start to produce Android phones, so these could be a good alternative option to importing phones.
- I made few measurements of the GPRS speed, using the SpeedTest.net Android app. I’ve put this information in a separate blog post (and will post a link here).
- Henock, one of the research assistants, has been doing a really good job of following up and training the HEWs. I think it also helps a lot that he is from the local area where the HEWs are based.
Another local mHealth project
Whilst in Adigudem, we visited the health centre where they are running another mHealth project – funded by the Clinton Foundation. It’s a very different system to ours, as it’s SMS based, any newly pregnant mothers are registered on the system (by a technician in the Health Centre), with basic information, such as name, location, LMP & EDD. Then when the EDD approaches the HEW receives an SMS to remind the woman to go to the Health Centre for delivery. The HEW needs to respond, using a code to inform the health centre that she has received the message and whether she has been able to contact the mother.
Elearning Thin Client Labs
We visited the elearning lab at Ayder campus, but unfortunately it seems neither of the 2 labs we set up are currently functioning. The main issue is that with both of the servers the disks are full, so no-one can save any of their files, and no new user accounts can be created. Fixing this should be straightforward with help from the university ICT team.
EMRS System at Ayder
Ayder Referral Hospital, where the Health Sciences College is based has recently implemented an electronic medical records system, using the SmartCare system, which is also being used in Zambia. It has been implemented throughout the hospital, with over 100 medical staff having access to use the system. There is some more info regarding the SmartCare system on their website, although it’s a little unclear to me whether this system is open source or not, or how any new modules can be developed (maybe only the original developers can create new modules?). If anyone has more info on this, then please let me know and I can update this posting.
We visited the Nurse and HEW training college in Mekelle and met with the College Dean, and in Addis we met with Tedla from AMREF, who has been working with the HEAT programme for the last few years. Both these meetings have given us a lot more insight into how the HEAT upgrade programme for HEWs is now working, since it has recently changed from a blended/distance based course to centre-based. A couple of the HEWs who were working with us have now joined the college in Mekelle, where they’ll be for the next year for their HEAT training. So we’re interested to see if we can run a short talk to the rest of the classmates about the case management tools they were using.
In all the visit went very well, we’re really pleased with the progress being made and how much everyone seems to like the HEAT on mobile application.