MOTECH Suite

This case study was originally published in the mHealth Compendium Volume 1, developed by the African Strategies for Health project, implemented by Management Sciences for Health with support from the U.S. Agency for International Development (USAID). Updates to the original case study appear in the final section of this case study.

Introduction

The MOTECH Suite delivers an integrated set of complementary mHealth applications that are scalable, sustainable and readily deployed. The collaborative community of development organizations behind MOTECH Suite has provided an open-source platform addressing the core needs of mobile health, creating a widely-deployed mHealth platform across a wide range of geographies and health interventions.

MOTECH Suite has been used by the Ghana Health Service to increase demand for antenatal care while simultaneously collecting service delivery information from community health workers. In six cities in India, MOTECH Suite is being used to provide care and treatment reminders to HIV-positive patients. In Bihar, India, BBC Media Action has developed services to increase frontline health workers communication skills and knowledge of life-saving maternal and child health behaviors. CARE also uses a MOTECH Suite system in Bihar to track pregnant women, mothers, and children under one along the continuum of care with specific protocols on birth preparedness, delivery, postnatal care, and exclusive breast feeding. World Health Partners is extending timely, quality access to tuberculosis diagnosis and treatment to Bihar’s rural population. World Vision has deployed MOTECH Suite-based maternal, newborn, and child health services in Afghanistan, Mozambique, and Zambia and has plans for scaling to Sierra Leone, Uganda, Tanzania, and Zambia.

MOTECH Suite comprises a set of complementary open source technologies from a consortium of partners, including Dimagi, Grameen Foundation, InSTEDD, OnMobile, ThoughtWorks, University of Southern Maine, and others. The MOTECH Suite consortium has core funding from the Bill and Melinda Gates Foundation, as well as project-specific funding from Johnson & Johnson, Government of Norway, and USAID, among others.

About MOTECH

MOTECH Suite functionality includes inter-operable workflows within and across five key functional areas: improving demand for health services, managing patient data, improving frontline worker performance, managing the last-mile supply chain, and tracking patient compliance with treatment. Capabilities include:

• Interactive Voice Response & SMS messages
• Educational Videos
• Pay-as-you-go subscription billing
• Registration by mobile form or IVR
• Record sharing across devices/workers
• Patient records
• Checklists and decision support
• Real-time worker feedback
• Supervisor alerts and tools
• Training
• Counseling support
• Real-time monitoring of stock levels
• Automated stock reports
• Automated reminders
• Referral tracking

Common features of MOTECH-based applications are listed below.

• Communicating information to patients via voice or SMS in the patient’s languages, according to their individual health needs, including reminders for appointments, taking medications, and childhood immunizations
• Collecting data from patients and caregivers to monitor service use and provision: patients report symptoms before and during treatment, give feedback on service delivery, and caregivers report which services they provided and when
• Alerting caregivers of the status of their patients’ health status by notifying them when patients have not taken prescribed medications and missed scheduled appointment
• Facilitating communication between patients caregivers, and/or health administrators by establishing secure peer networks for patients with common concerns and initiating conversations between patients and caregivers in a way that allows the caregiver to manage the workload most effectively

Evaluation and Results

MOTECH Suite has supported Ghana’s Mobile Midwife Program for more than two years. There, MOTECH covers 46 facilities and over 1,100 active mobile midwives, and has more than 21,000 registrants. It has delivered nearly 58,000 SMS and voice messages, provided training for 165 CHWs, and uploaded over 134,000 patient records.

The Ghana program is considered a great success. It is being expanded into three new districts in 2012-2013 and the Ghana Health Service is taking on increased management responsibilities as part of a planned transition to deployment across the entire country.

Lessons Learned

Key lessons in using the MOTECH Suite platform in Ghana include:

• Low cost Java-enabled handsets proved to be a more suitable than those which were solely SMS compatible, due to greater capacity to enter data and cheaper data transmission costs;
• Content needs to be locally relevant and delivered in local languages to have impact in rural communities;
• Close integration and collaboration with existing health system operations from the outset is essential; and
• Expect different usage rates for mHealth services based on phone ownership profiles.

Conclusion

MOTECH Suite has great potential to make a difference in the quality of health care delivery and status. The program is steadily growing in scale and maturity and has a strong consortium of partners contributing both technology and field implementation expertise.

PROJECT UPDATES

The MOTECH implementation in Ghana began in 2010 and ended in 2015, when the project ended. In Ghana, MOTECH consisted of two mutually supporting mobile phone applications: Mobile Midwife and the Client Data Application (CDA). Rural women experienced Mobile Midwife as an automated voice message service that delivered weekly educational messages to their mobile phones, timed to their gestational age or the age of their infant. Community health nurses engaged with the CDA to digitize information on the health services they provided and to better track and deliver care to women and infants. Aspects of the CDA were leveraged by the Ghana Health Service to design and develop the e-Tracker tool—the android app that provides an offline alternative to its traditional online web-based data capture and reporting tools—which is currently still in use.

Key lessons learned from the MOTECH implementation in Ghana summarized in the 2015 report include:

• Low income rural women were willing to listen to and trust mobile voice messages on maternal, newborn, and child health (MNCH) topics. MOTECH’s internal monitoring found that in five of the seven districts (excluding two that had severe network problems), between 85 and 91 percent of pregnant clients actively listened to more than 50 percent of the messages they received.
• Localizing health messages and making them actionable was key. The high levels of trust and interest that were shown by Mobile Midwife clients stemmed, MOTECH believes, from tailoring the messages to the clients. Tailoring the messages included ensuring that the particulars of health-seeking behavior—what foods to eat, when to initiate breastfeeding—were localized not only so they could be readily acted on but also so they could address any harmful local myths.
• The integration of voice messaging with customized reminders and alerts based on client data was the most powerful feature of MOTECH. While designing and running one-way messaging alone was simpler, and enabling uploads of client care data alone was more straightforward to operate, neither on its own were as powerful as integrating messaging and care data.
• Easy mobile phone access was crucial to the success of a mobile messaging service, and many women in rural Ghana still lack this. For clients without phone access, the technical solutions MOTECH attempted to work around the problem—primarily the free call-in feature that allowed women to use community phones—did not solve this problem. Personal intervention by community volunteers assisting women to listen to their messages on the volunteers’ phones was more effective.
• A mobile-based client data system like MOTECH’s could be of real value to community health workers, but maintaining data accuracy and completeness required surmounting some large challenges. The usability and reliability of the data in automated reports that were generated based on the information entered into the client data system depended heavily on health workers’ mastering clinical data entry and uploading at a high standard of accuracy and consistency. This proved to be too difficult for the higher-client-volume health centers and hospitals, where overburdened midwives and siloed treatment areas meant client data handling was a low priority. Yet these health centers and hospitals were where most of the standard MNCH care needed to be provided.

A system like MOTECH could work on a national scale in Ghana, provided certain practices and adaptations were put into place:

• Once the large initial investment is made in high quality, culturally adapted content and appropriate translation and voice recording, the scale-up of Mobile Midwife would consist of marketing and community engagement, ongoing monitoring and troubleshooting to ensure that women get their messages, and periodic content refreshing. Gaining full participation of the target group, however, would require addressing the phone ownership problem. 
• Rolling out a system like the CDA so that it could reliably produce automated reports and yield complete client data would require that at least two major challenges be overcome: (1) the serious challenges in data entry and uploading encountered at the higher level health facilities, and (2) the common practice of women switching between public and private health facilities, even during a single pregnancy, which leaves care records incomplete. 

Innovative public-private partnerships are needed for a system like MOTECH to be sustainably financed and operated on a national scale in Ghana. Scaling up MOTECH’s client data system could be particularly challenging, given the training and monitoring required.

Mobile health solutions intended for broad use within the public health sector should be designed for national rollout from the beginning to ensure that key components are fully integrated into government management structures and practice standards. For this to happen, government at the highest levels needs to lead strategic decisionmaking about technology and implementation choices. 

More details on the experiences and lessons learned from the five years of MOTECH implementation in rural Ghana are available here. 

References/Resources

Original Case Study

Information was excerpted from:

MOTECH Suite: http://motechsuite.org

Mobile Technology for Community Health in Ghana; What it is and What Grameen Foundation has Learned So far; Second Edition: September 2012 http://www.grameenfoundation.org/sites/default/files/MOTECH-Lessons-Learned-Sept-2012.pdf

Mobile Technology for Community Health in Ghana: http://healthmarketinnovations.org/program/mobile-technology-for-communityhealth-motech

Project Updates

Grameen Foundation, “Mobile Technology for Community Health in Ghana: What It Is and What Grameen Foundation Has Learned So Far,” September 2012, 

https://grameenfoundation.org/documents/5ozoc8ste2hjjkxekff8.pdf.

Grameen Foundation, “Using Mobile Technology to Strengthen Maternal, Newborn, and Child Health: A Case Study of MOTECH’s Five Years in Rural Ghana,” 2015,

https://grameenfoundation.app.box.com/v/MOTECHGhanaReport.

Note: this project update was produced by PRB based on the references listed above.