mhealth osana äiti-lapsi - terveyttä Africassa, case Mosambik ja Sambia Kuva: http://www.mhealthafrica.com/ Pirkko Kouri, TtT, yliopettaja terveydenhuollon teknologia Savonia-amk, Terveysala, Kuopio
Sisältö mhealth taustaa Afrikka - Äiti-lapsi terveys Mosambik Sambia Esimerkkejä mhealth solutions Tulevaisuus
mhealth described as the application of wireless technologies in delivery of health services Portable wireless devices such as tablet computers, laptops, Personal Data Assistants (PDA), Radio Frequency Identification (RFDI) devices and mobile phones used in mhealth. The devices are portable (any where), supporting immediacy (any time), convenience (easy to access), reasonable cost (relatively low unit cost) and pervasiveness (widely spread), personalised & socialised (symbiotic with leisure, sport, entertainment, friends & family) mhealth services may include diagnostic and treatment support, remote patient monitoring, disease surveillance and data collection, health promotion, disaster crisis response, medication reminder and helpline systems
did this Global mhealth Developer Survey (2010) Objective: Obtain developers perception of mhealth status, drivers and barriers Method: Online questionnaire Participants: 231 companies involved in mobile health market http://www.google.fi/url?sa=t&rct=j&q=&esrc=s&source=web&cd=5&ved=0cfuqfjae&url=http%3a%2f%2fwww.hie.co.uk%2fcommon%2fhandlers% 2Fdownload-document.ashx%3Fid%3D112edd08-7612-4d28-935f- 206b19cd7068&ei=pR9BUuS_AaG24wSgvYDQAQ&usg=AFQjCNEzr7lv0tWSfxQ3iFFHYxUSsX_- Nw&sig2=TTHPwmM_t3OCrb8j23nbYQ&bvm=bv.52434380,d.bGE
Health information Personalised feedback Kuva esityksestä Knowledge-Intensive ICT Services for Health and WellNess 22.11.2011, Eero Punkka, ICT for Health, Wellness and Environment, mukaellen P Kouri
Citizens viewpoint Better access to health services and improved health outcomes Right care - right patient - right medication - right time right documented (literate) --------------- ICT and e/mhealth ----------------- Anyone can now learn anything from anyone at any time. (also illiterate)
Afrikka Case Mozambique & Zambia
Zambia Mozambique
Afrikan koko
Urban area living
Health Indicators Mother and Child Health Indicator Mozambique > 25 milj. Finland* Life expectancy at birth m/f (years) 52/53 (2009) 77,2/83,5 Probability of dying under five (per 1 000 live births) Mortality Rate under 5 years (per 1.000 live births) 90 4,1** Maternal Mortality Rate (per 100.000 live births) 408 3 (2010) Mosambik: http://www.who.int/countries/moz/en/index.html *virallinen tilasto (SVT): Kuolemansyyt [verkkojulkaisu]. ISSN=1799-5051. 2010, 6. Lapsikuolleisuus 1936 2010. Helsinki: Tilastokeskus [viitattu: 22.9.2013]. ** Perinataalikuolleisuus (ensimmäisen viikon aikana kuolleet sekä kuolleena syntyneet)
Health Care in Mozambique (similarities to Zambia) Acute shortage of qualified staff; Fragmentation of the health systems; Marginal percentage of the population having access to effective health care; Imbalance in facilities and infrastructure; Health Sector Recovery Program launched by the government in 1996 with aim to: Increase first-level health units (health centers and health posts); In year 2010 is estimated that 50% of the population have access to the health system Each District Health has at least one Medical Doctor!!! Source: Presentation by Gertrudes Macueve and Emílio Mosse May 5 th, 2010 at Savonia in Kuopio - Finland
Mozambique personal ID First babies get a hospital card/an ID that's valid as an identification document anywhere (with the parents name, place of birth etc.) Normally babies get an ID that's valid as an identification document anywhere (with the parents name, place of birth etc.) only after the parents register the baby (at the notary/population Register Center). It can take long to register the baby. It depends on the parents. Before that the only document that the baby has is the hospital card. The babies who have to go to the nursery for special attention (because they are sick) are the ones who get card later. The baby has to carry the card for every consultation, weight control or immunization appointment. But that's a card that is only valid in the National Health System (Description of Mozambican woman) There are also citizens who are not registered anywhere
Health Indicators Mother and Child Health Indicator Zambia > 14 milj Finland* Life expectancy at birth m/f (years) 54/56 (2009) 77,2/ 83,5 Probability of dying under five (per 1 000 live births) Mortality Rate under 5 years (per 1.000 live births) Maternal Mortality Rate (per 100.000 live births) Source: Indexmundi http://www.indexmundi.com/zambia/maternal_mortality_rate.html 89 (2009) 4,1** 440 (2010) 3 Year 2010 Zambia: http://www.who.int/countries/zmb/en/ *virallinen tilasto (SVT): Kuolemansyyt [verkkojulkaisu]. ISSN=1799-5051. 2010, 6. Lapsikuolleisuus 1936 2010. Helsinki: Tilastokeskus [viitattu: 22.9.2013]. ** Perinataalikuolleisuus (ensimmäisen viikon aikana kuolleet sekä kuolleena syntyneet)
Zambia baby is given a number at birth called MCH Child s number which is used for all under 5 year at clinics, but if a baby is sick she & he will give a book with a different number, which can be used whenever one is sick at that particular health centre. on the under 5 year card and birth certificate, place of birth and residential ad are included, national registration card includes your village and chief but all these carry different numbers. the most important number is national registration card number because it is used for employment as well, but those who work or retired will also have a social security number with the national pensions scheme authority. this scheme workers contribute monthly amounts before retirement age and then get that money after one has retired. (Description by Zambian father) There are also citizens who are not registered anywhere
Examples of mhealth solutions in less recourced countries in Africa
Adoption of mhealth initiatives and their phases, by WHO AFRICA region Lähde: mhealth. New horizons for health through mobile technologies. Based on the findings of the second global survey on ehealth. Global Observatory for ehealth series - Volume 3. WHO 2011
Manhican terveystutkimuskeskus CISMn käyttämä mobiililaite http://www.manhica.org/
Manhiça Health Research Centre/Mosambique. Manhican terveystutkimuskeskus CISM
Mobiililaitteita käytetään syrjäseutujen asukkaiden identifioimiseen ja paikallistamiseen. Laitteilla kerätään ihmisten sormenjäljet ja kodin gps koordinaatit. Tekstiviesteillä ihmisiä kutsutaan terveystarkastuksiin ja muistutetaan rokotuksista. Laitteilla on keskeinen rooli keskuksen käyttämässä Training in field koulutusmenetelmässä, jolla terveydenhuollon toimijoita koulutetaan kenttäoloissa.
Malaria Control and Evaluation Partnership in Africa (MACEPA) PATH National Malaria Control Centre/Zambia http://www.makingmalariahistory.org/about/about-macepa-malaria-control-and-evaluation-partnership-inafrica/ Lusakassa sijaitseva keskus käyttää matkapuhelimia mobiiliraportointiin maaseudun malariatilanteen seuraamiseksi. Yhteisöterveystyöntekijät (Community Health Workers) keräävät tietoa ja välittävät ne keskuksen järjestelmiin tekstiviesteillä. Reaaliaikaisen tiedonkeruun avulla saadaan kokonaiskuva malarian leviämisestä ja kohdennetaan hoitoresursseja oikealle alueelle
Clinton Health Access Initiative, overseeing SMS Printer project / Zambia http://www.clintonhealthaccess.org/ Maailmanlaajuinen toiminta, Lusakassa sijaitseva keskus, jossa hyödynnetään matkapuhelimia HIV/AIDS työssä Maan kehnojen kulkuyhteyksien takia kylissä tehtyjen terveystestien tulosten lähettäminen takaisin kyliin on kestänyt pitkiä aikoja. Mobiiliviestinnän ansiosta tieto HIV/AIDS tartunnasta saadaan nopeasti kyliin. lapsille on kriittistä päästä hoitoon pian tartunnan saamisesta.
Cell-Life-Using Cellphones in Medical Abortion study/south Africa http://m.ichoosewhen.org.za/ Quick facts Injections The Pill IUDs Condoms Natural methods Permanent methods Emergency contraception Abortion Infections For HIV+ Get help (If you think you may be pregnant, DO A PREGNANCY TEST AS SOON AS POSSIBLE you can get these tests from the pharmacy or your clinic or doctor) MAMA SMS (service is freely available and was designed for expecting mothers and mothers with a baby less than 3 months old. You can choose to receive messaging in isizulu, isixhosa, Sesotho, English and Afrikaans)
MDNet http://www.africaaid.org/programs/mdnet MDNet tarjoaa lääkäreiden välisen ilmaisen kommunikaatiokanavan, joka tarjoaa hätätilanteissa nopean tiedotuksen, tietämyksen jakamisen, mahdollisuuden terveydenhoidon laadun parantamiseen ja ihmishenkien pelastamiseen. Kanava on laajentunut Liberiaan. (MDNet Liberia already has 100% of Liberian doctors linked on the free communication network.) Hesperian Health Guides http://hesperian.org/books-and-resources/safe-pregnancy-and-birth-mobile-app/ on julkaissut ilmaisen mobiilisovelluksen Safe Pregnancy and Birth Mobile App, joka sisältää tietoa mm. raskausajan terveyden edistämisestä, ongelmien tunnistamisesta ja mitä tulee tehdä, jos ongelmia esiintyy sekä ohjeita yhteisöterveystyöntekijöille terveysarvojen mittaamiseen.
Hesperian Health Guides example of mhealth information
Äiti-lapsi terveys ja mhealth kehittämishanke FinMNCH mhealth Cloud Service Measuring mobile service centre for mother - child health care, utilising MNCH basic work Monitoring Interview Support Training
Future..Games for Health Games are rapidly becoming an important tool for improving health behaviors e.g. healthy lifestyle habits and behavior modification to self-management of illness and chronic conditions to motivating and supporting physical activity. Games are increasingly used to train healthcare professionals in methods for Diagnosis medical procedures patient monitoring responding to epidemics and natural disasters.
Photos during visit to Zambia Spring 2013 Kiitos