Characterizing the Flow of Health Information in Rural Uganda: Is There a Role for Mobile Phones?

Transcription

1 Characterizing the Flow of Health Information in Rural Uganda: Is There a Role for Mobile Phones? Laura E Jacobson UW Public Health Symposium November 1, 2013

2 OUTLINE Background Study Setting Methods Analysis Results Conclusions

3 BACKGROUND WHO: Systems thinking for health systems strengthening

4 Health Information System (HIS) A well-functioning HIS includes production, analysis, dissemination and use of accurate and timely information on determinants of health health systems performance metrics health status of the population Connecting policymakers with reliable health information can strengthen decision making guide priorities ensure accountability

5 Health Information System: Uganda Evaluations by Ministry of Health showed consistent problems: completeness accuracy timeliness Incomplete Census inaccurate denominator Underrepresentation of those in hard to reach areas Lack of connectivity between centers Assessment of health facility data quality: Data quality report card Uganda,

6 UN s Post 2015 Development Agenda Data Revolution Improve the quality of statistics Increase accessibility of information Take advantage of technology

7 mhealth The practice of medicine and public health supported by mobile devices Ex: SMS medication reminders, public health campaign blasts, surveillance to inform policy Gap in the literature on evaluated/evidence based interventions Lack of coordination with Ministry of Health and public health sector Photo: gsma.com (Déglise et al. J Med Internet Res 2012;14(1):e3)

8 GOAL To understand if mobile phones may play a role in strengthening the HIS by connecting policymakers with timely health information by characterizing the flow of information between health workers and policymakers in Uganda

9 OBJECTIVES Aim 1: To analyze the direction and type of health information transmitted between health workers and policymakers Aim 2: To assess attitudes of mobile phone use in the health system from health workers and policymakers

10 SETTING: Mbarara and Sheema Districts Population 436,400 and 215,000 Mbarara University of Science and Technology (MUST) Uganda Bureau of Statistics

11 LOCAL GLOBAL COMPARISON Dane County Mbarara District Population 503, ,400 Size 1238 sq miles 713 sq miles % Rural 15% 81% Median Annual Household Income $61,913 USD $1,310* USD Primary Care Physicians 2.16 per 1,000 population 0.12* per 1,000 population Number hospitals 5 1 * Western Region Higher local government statistical abstract mbarara district 2011

12 METHODS Semi-structured, in-depth interviews with health workers and policymakers General questions Health information Reporting procedures Health system vulnerabilities Mobile phones (mhealth) attitudes and perceptions Other topics: community health, vaccine coverage

13 ETHICS Mbarara University of Science and Technology IRB University of Wisconsin Madison Health Sciences Minimal Risk IRB Written informed consent obtained from all participants Confidential interviews

14 SAMPLE Interviews took place between May and July 2013 Policymakers (n=11) District health officers (DHO) (n=2) District level administrators (n=4) Local councilors (LC) (n=4) Members of Parliament (MP) (n=1) Health workers (n=9) Nurse midwives (n=3) Doctors (n=3) Health facility directors (n=3)

15 ANALYSIS Identify characteristics of information system and evaluate differences between health workers and policymakers Audio-recorded transcripts were transcribed and organized with NVivo software Coded and scored to answer: Frequency and type of health information Direction of information flow Attitudes towards mhealth

16 ANALYSIS: Frequency and Type of Information Used Type of health Information Anecdotal reports Detailed statistics Compiled and analyzed summaries Digital (web or mobile phone) Each type of information scored for frequency of use never or rare (0) occasional use (1) routine use (2) These scores were averaged for each group health workers vs. policymakers t-tests were used to test for difference between groups

17 ANALYSIS: Attitudes towards mhealth Scored for perceptions of mobile phones use for for health negative (0) neutral (1) positive (2) These scores were averaged for each group health workers vs. policymakers t-tests were used to test for difference between groups

18 RESULTS: Frequency and Type of Information Average Frequency Index Score (Rare/Never 0, Occasional 1, Routine Use 2) Type of Information Health workers n=9 Mean (SD) Policymakers n=11 Mean (SD) P value Anecdotal reports 2 (0) 0.55 (.93) <0.001 Detailed statistics 1.78 (0.44) 2 (0) Compiled and analyzed summaries 0.44 (0.88) 1.36 (0.92) Digital 0.33 (0.50) 0.55 (0.52) 0.351

19 RESULTS: Direction of Information One way channel of communication Health workers Policymakers Seven of nine (78%) health workers stated that they sent health reports to the district routinely No health workers reported receiving routine reports from policymakers All eleven policymakers (100%) reported receiving reports; none mentioned reporting back to the health workers

20 RESULTS: Attitudes towards mhealth (Negative 0, Neutral 1, Positive 2) Health workers n=9 Policymakers n=11 P value Mean index score (SD) 1.22 (0.67) 1.36 (0.67) 0.648

21 I think [mhealth] is the way to go because many interventions are using the mobile platform now: you can do money transfers, you can easily get information to and from people. It is the way to go. -Policymaker

22 [mobile phones] have been found very useful but there are issues with sustainability. The barrier to this problem is financing the technology. And phones are things that can easily get lost, can easily get stolen, they can fall and break, and for how long are we going to repair and replace. Health worker

23 CONCLUSIONS Health Information Bi-directional channels of communication between health workers and policymakers would strengthen the health information system Increasing health worker s access to compiled and analyzed summaries may reduce the reliance on anecdotal reports and improve decision making

24 CONCLUSIONS Mobile Phones Over all positive outlook from those interviewed Concerns: sustainability, scalability, cost, technical problems Potentially address timeliness issue and connectivity, not accuracy or need for compiled summarizes Have the end-users involved in the development of the tools to ensure they meet the needs of those who may eventually use them

25 WHO: Systems thinking for health systems strengthening

26 LIMITATIONS Small sample (n=20) Only 2 districts sampled Interviews conducted by a visitor Participants limited to English speakers Recruitment subject to convenience Subjective analysis Need to have coding confirmed by additional author

27 Capstone Committee Francis Bajunirwe, PhD, Msc, (MUST) Ajay Sethi, PhD, MHS (UW Pop Health) James Conway, MD (UWSMPH) Monica Grant, PhD (UW, Sociology) Field Team Leonidas Twesigye (MUST) Bryan Vonasek (UWSMPH) Henry Tumwebaze (ICOBI) Study Participants MUST MPH Program Barb Duerst, MS Tom Oliver, PhD, MHA Program Staff Global Health Institute Lori DiPrete Brown, MS, MTS Department of Medicine Cindy Carlsson, MD, MS ACKNOWLEDGMENTS

28 REFERENCES Beehr TA, Newman JE. Job Stress, Employee Health and Organizational Effectiveness: A Facet Analysis, Model, and Literature Review. Personnel Psychology 1978 vol 31(4) pg: Déglise et al (2012). Short Message Service (SMS) Applications for Disease Prevention in Developing Countries J Med Internet Res; 14 Crabtree B, Miller W. Doing Qualitative Research. Sage Publications Inc Gladwin J, Dixon RA, Wilson TD. Implementing a new health management information system in Uganda. Health Policy and Planning; (2): Hodges BC and Videto DM. Assessment and Planning in Health Programs. Jones and Bartlett accessed October 20, John Hopkins Center for Clinical Global Health Education Accessed October 3, Ministry of Health Uganda. Assessment of health facility data quality: Data quality report card Uganda, Uganda Bureau of Statistics United Nations (2013). A New Global Partnership: Eradicate Poverty and Transform Economies through Sustainable Development. The Report of the High-Level Panel of Eminent Persons on the Post-2015 Development Agenda. World Health Organization (2007). Strengthening Health Systems to Improve Health Outcomes: WHO s Framework for Action.

29 QUESTIONS?