Mobile Technology for Community Health (MOTECH)

Mobile phones have become a pervasive technology in developing countries. But can information delivered over a mobile phone change the outcome of a pregnancy? Can a network of mobile phones be deployed that coherently engages communities and healthcare workers to save the lives of newborns?

Grameen Foundation has launched an initiative to determine how best to use mobile phones to increase the quantity and quality of pre- and post-natal care in rural Ghana. Funded by a grant from the Bill & Melinda Gates Foundation, the Mobile Technology for Community Health (MOTECH) initiative is a collaboration with Columbia University's Mailman School of Public Health and the Ghana Health Service. The two-and-a-half-year project offers a suite of services delivered over basic mobile phones that provides relevant health information to pregnant women and encourages them to seek pre-natal care from local facilities. After the birth, the system addresses common questions about newborn care. Simultaneously, the MOTECH system helps community health workers identify women and newborns in their area who need healthcare services and automates the process of tracking patients who have received care.

For a detailed summary of the program and lessons learned, read our MOTECH in Ghana Report [1].

The MOTECH Suite
Expanding on the capabilities of MOTECH is the MOTECH Suite, a consortium that brings together several of the most experienced mHealth implementers, open-source solution providers and funders (including Dimagi, Grameen Foundation, InSTEDD, OnMobile, OpenMRS, ThoughtWorks, University of Southern Maine and others) in an open ecosystem of partners. Using best practices such as open-source development and software as a service (SaaS), the consortium provides a firm foundation of field-proven applications covering a diverse range of capabilities. The MOTECH Suite consortium has core funding from the Bill and Melinda Gates Foundation, as well as project-specific funding from such organizations as Johnson & Johnson, USAID and the government of Norway.

Find out more about the MOTECH Suite by visiting its website [2] or reading this overview [3].

Background
In 2000, the Government of Ghana scaled up its community-driven approach to healthcare services. Known as "CHPS" (Community-based Health Planning and Services Initiative), the program relocated nurses from clinics to communities and mobilized volunteerism and social support for their work. Unfortunately, the program failed to achieve its full promise as a scaled-up service system, because community nurses often base their work in village health posts, failing to provide much-needed doorstep care. Needs associated with pregnancy, delivery and early infancy remained neglected, in part because information available to nurses and volunteers was inadequate for supporting home-based services to newborns.

MOTECH alters this dynamic by enabling the delivery of relevant and actionable information over mobile phones. Pregnant women register by providing their phone number, the name of the area in which they live, their estimated due date and their language preference. They then begin receiving SMS and/or voice messages that provide information about their pregnancy (e.g., milestones in fetal development), the location of the closest health facility and specific treatments that they should receive during their pregnancy (e.g., tetanus vaccination).

Some of the messages the woman receives are specifically relevant to her history of receiving antenatal care. For example, someone who has not received a tetanus vaccination will receive a message specifically about the importance of tetanus immunization. Services also enable an expectant mother to send health-related questions via SMS and receive an automated response that is relevant to her question. Once her child is born, the mother receives messages and information about essential vaccinations for her child and how to manage critical childhood illnesses.

Specific tools have also been created for community health workers, who expend a huge amount of energy and effort tracking patients and services in a wide range of forms and registers. In close consultation with the Ghana Health Service, MOTECH has established a simplified patient register; information from this register is entered into MOTECH via the health workers' mobile phone, simplifying daily recordkeeping as well as vastly reducing the amount of time spent aggregating data for monthly reports. Because prenatal interventions are recorded using this system, MOTECH is able to send messages to expectant mothers if they miss critical prenatal care, healthcare workers can receive feedback about the number of women in their area who have received proper antenatal care, and administrators in the health system can track the delivery of services across specific geographies.

If you are interested in implementing a mobile health program, you should learn more about the MOTECH software platform [4].