Mobile Health Around the Globe: Ghana – Changing the Very Essence of Healthcare

Ghana faces some serious challenges when it comes to healthcare delivery.

Ghana faces some serious challenges when it comes to healthcare delivery.

As the Austrian Red Cross points out, although the country has a population of nearly 23.5 million people, there are only 1,439 health care facilities, unevenly distributed across the country.

Additionally, roads are difficult to traverse, and transportation, particularly to rural areas scarce.

Add to the above difficulties a nursing shortage–more nurses leave than graduate each year.

In short it is often lack of access to medical care, rather than poor medical care itself, that impedes Ghana’s progress.

Enter mobile health.

It is just such access–and what it can accomplish–that is changing the face of healthcare in Ghana

Unlike the individual monitoring. tracking, and personal interactions with clinicians via applications in developed countries, mobile health in Africa  focuses on “improving the efficiency of healthcare workforce and systems.”

Four major mobile health projects currently operating in Ghana demonstrate this focus.

#1: Sene PDA Project 

The first mobile project in Ghana, the PDA project was initiated in the Sene District in 2004 to improve treatment at initial levels of care.

The use of PDAs (as opposed to more primitive systems of record keeping) provides a tool for tracking and locating children who fail to finish the immunization process. The Community Health Officers at the first level of service delivery register children receiving immunizations, provide them with a unique identification number, and record their addresses for home visits or follow-up care.

 

source credit:Ghana Health Service

At each community visit the Officer makes to an outreach clinic, this registry instantly provides the names of the children to be vaccinated as well as which vaccines they have already had and those they still require.

The Policy Planning, Monitoring, and Evaluation Division of the health service assert that the drop-out rates for the vaccine against Diphtheria, whooping cough, Tetanus, Hepatitis B and H. influenza infections) dropped from 5.3% to 1.8% since the program was initiated.

The project was such a success that it has been replicated across the country, and PDAs are being phased out in favor of smartphones.

It t may have been the first to use mobile technology to improve healthcare in Ghana–but it is far from the last.

The Millennium Villages mhealth project moved the arena from vaccinations specifically to supporting rural health in general.

#2 Millennium Villages mhealth projects

The Novartis Foundation and the  Millennium Villages Project joined forces with the Ministry of Health and the Ministry of Communications in Ghana, National Health Insurance Agency Ghana, Ghana Health Service, and Ghana Medical Association, to make accessible  mobile technology to improve the quality  of primary health services, particularly in rural areas.

Initially the Millennium Villages project provided an ambulance for Bonsaaso, in the Ashanti Region of Ghana.

But the maternal death rate did not go down, since women couldn’t communicate with ambulance dispatchers about their locations due to unreliable phone lines.

Mobile handset producer Ericsson, together with mobile telecommunications firm Zain, cooperated to install Internet access and mobile phone coverage throughout the area. They gave free phones to health workers and sold them to villagers for $10 each.

 

The introduction of mobile phones has made a tremendous difference in maternal women’s survival.  With those phones given out by Ericsson, for the first time women can call ambulances in cases of emergency–and ambulance drivers can reliably receive the calls and reach the area of need.

Before cell phone and internet technology were introduced to the village in 2006, around 20 women a year died in childbirth. In 2008, after the mobile program began, not one died.

An even more innovative component of Millennium Villages is the Ghana telemedicine project. As the Novartis Foundation explains, in Bonsaaso there are only seven health centers for 32,000 people, requiring long travel, often over unpaved roads. It can take hours for a patient to reach a clinician, and then the wait time can be long enough to be dangerous.

This project focuses on minimizing unnecessary referrals to congested centers, and utilizing consultations via mobile phone so local heath care providers can gain the requisite knowledge to treat patients within their own communities.

photo credit: Novartis Foundation

A teleconsultation center has been set up, manned by physicians working at the main hospital.

“Now,” claim the proud funders, “health workers, nurses and other personnel are able to engage in structured consultation with doctors at the district hospital, as a result reducing unnecessary referrals and allowing for immediate support in the event of medical emergencies.”

Along similar lines the program has created ChildCountPlus application. Utilizing the mobile phones, the community health workers collect and synthesize data about their patients, with a particular focus on children and malnutrition.

Their ongoing goals are to register every child under five into the database, screen them for signs of malnutrition every 90 days, and monitor them for the three major causes of child death: malaria, diarrhea, and pneumonia.

In Millennium Villages where screening programs for malnutrition have been enacted, rates of malnutrition (assessed by ‘stunting,’ or a low height for age ration, indicating chronic malnutrition) have decreased more rapdily than in locations without the intiative.

 

#3 SMS for Life 

Sub-Saharan Africa accounts for 90% of malaria deaths world-wide, resistant to many on-the-ground efforts to combat it. Crucial malaria medications would run short in certain areas, leading to epidemics, while elsewhere the medicine went to waste.

A method of accounting for medicine stockpiles and ensuring the right amounts of treatment were in the right areas was needed–and mobile access supplied the technology to match up medication and demand.

SMS For Life was first piloted in Tanzania, utilizing SMS messages to keep track of anti-malarial supplies and prevent shortages.