OVATE EVALUATE ALE UP IMPROVE ALTH RESEARCH ALUATE SCALE UP PROVE INNOVATE ALUATE SCALE UP PROVE HEALTH
Facilitating follow-up and retention among HIV+ mothers and exposed infants in Malawi – CHAI’s Mother-Infant Pair clinic In Malawi, the loss to follow-up rate of patients on HIV care and treatment has been unacceptably high. In 2012, 100 624 patients (18%) were lost to follow-up – they did not receive life-saving antiretroviral therapy (1). The Clinton Health Access Initiative (CHAI) in Malawi piloted a ‘one stop shop’ for postpartum Prevention of mother-to-child transmission services called the Mother-Infant Pair (MIP) clinic. The MIP clinic provided early infant diagnosis, immunizations, psychosocial support, and HIV care and treatment services for HIV-positive mothers and their infants. FrontlineSMS – a free text messaging software – connects the MIP clinics with community health workers (CHWs) so they can actively track and follow up patients to improve the continuity of care for mothers and their infants. How CHAI’s Mother-Infant Pair clinic works SMS reminders are sent to community health workers (CHWs) to follow up with HIV-positive pregnant and lactating women who miss an appointment. Each time a health-care worker at the MIP clinic registers a mother, he/she sends an SMS (text message) from a basic cell phone to the central server at the district hospital to register the mother with the FrontlineSMS system. The clinic health worker follows up with an SMS to the local CHW in the client’s village if the client misses an appointment or if the test results for the infant arrives at the health facility. This ensures that the client and her infant are not lost to follow-up. The CHW confirms with the health worker that he/she has communicated with the client, and in turn the health worker then confirms with the CHW once the mother and child have returned.
Supporting national public health programming The mHealth solution aims at assisting the Malawi Government and partners to scale up FrontlineSMS in order to successfully trace and retain 95% of all MIPs who miss their appointments. This aim is consistent with the 2012 Malawi National Strategy for the Elimination of Mother-to-Child Transmission of HIV (2). The Ministry of Health (MOH) has endorsed the scale-up of FrontlineSMS for this purpose. MOH is also actively involved with negotiating a public-private partnership agreement and has established a National Technical Working Group for mHealth technology. The FrontlineSMS system intends to strengthen existing patient follow-up efforts by expediting communication between clinic-based health-care workers and CHWs, and by minimizing paper work.
Partnerships for support and sustainability CHAI has built strong partnerships with the government and other implementing partners to achieve long-term impact on HIV treatment and testing for mothers and their children. The MOH at the national level has been actively involved in policy direction, while at the district level MOH staff are involved in trainings, patient follow-up and management of the hub. Partners including the United
HIV+ MIP clinics ensure HIV+ patients are not lost to follow up HIV+ mothers who attend a local clinic receive an SMS one week before their follow-up appointment planned for 2014 If the client misses her follow-up appointment the CHW is alerted via SMS CHW locates client and reminds her to attend clinic Health records for mother and child updated Mother and child receive complete health care services
Nations Children’s Fund (UNICEF) and Médecins Sans Frontières (MSF) work with CHAI in implementing an mHealth system that expedites delivery of test results to health facilities. The MOH plans to lead negotiations with mobile network operators for reduced airtime costs and improved telecommunication services to ensure the sustainability of the system. It will eventually adopt the system and scale it up nationally, with support from UNICEF and MSF.
Mangochi District
7
14
85
294
210
Salima District
3
6
45
126
90
IWG catalytic grant for mHealth programme scale-up CHAI was awarded a grant to scale up the use of MIP clinics in Malawi by the United Nations Innovation Working Group’s (IWG’s) catalytic grant competition for maternal, newborn and child mobile health (mHealth), managed by the mHealth Alliance. CHAI Malawi was successful in the grant competition because it employs an effective delivery strategy for an evidence-based maternal and child health intervention, combined with creative financing strategies to promote sustainability – elements that are critical for mHealth tools to contribute to Millennium Development Goals 4 and 5.1 Through IWG, CHAI Malawi is receiving specialized assistance from WHO’s Department of Reproductive Health and Research to optimize the scale-up of MIP clinics while contributing to the mHealth evidence base and best practices on implementation and scale-up. 1 MDG 4 is to reduce child mortality; MDG 5 is to improve maternal health (www. unmillenniumproject.org/goals/gti.htm)
Malawi Number of facilities Number of HCWs trained in SMS Number of CHWs trained in SMS Number of mother-infant pairs in SMS sites only (2013 target) MIPs to be reached, PRIME SMS sites only (2014 target)
Partners: Foreign Affairs, Trade and Development Canada; Malawi Ministry of Health and Malawi College of Medicine For more information please contact: For more information please contact: Emily Churchman, Senior Program Manager, MNCH (echurchman@clintonhealthaccess.org) or Adrian Stuart, Country Director, Malawi (astuart@clintonhealthaccess.org)
References: 1. Malawi Ministry of Health. Integrated HIV Programme Report October–December 2012. Government of Malawi, 2012 (http://www.hivunitmohmw.org/ uploads/Main/Quarterly_HIV_Programme_Report_2012_Q4.pdf). 2. Malawi Ministry of Health. Malawi National Plan for the Elimination of Mother-to-Child Transmission of HIV. Government of Malawi, 2012 (http:// www.emtct-iatt.org/wp-content/uploads/2012/11/Malawi_National-eMTCT-Plan_2012.pdf). Credits: Icons from The Noun Project designed by: Jack Biesek, Gladys Brenner, Margaret Faye, Healther Merrifield, Kate Keating, Wendy Olmstead, Todd Pierce, Jamie Cowgill and Jim Bolek, Matt Daigle, Ben Rex Furneaux Photo: Selina Walusa, CHAI Editing, design and layout: Green Ink (www.greenink.co.uk) WHO/RHR/13.23 © World Health Organization, 2013 The designations employed and the presentation of the material in this publication do not imply the expression of any opinion whatsoever on the part of the World Health Organization concerning the legal status of any country, territory, city or area or of its authorities, or concerning the delimitation of its frontiers or boundaries. Dotted lines on maps represent approximate border lines for which there may not yet be full agreement. The mention of specific companies or of certain manufacturers’ products does not imply that they are endorsed or recommended by the World Health Organization in preference to others of a similar nature that are not mentioned. Errors and omissions excepted, the names of proprietary products are distinguished by initial capital letters. All reasonable precautions have been taken by the World Health Organization to verify the information contained in this publication. However, the published material is being distributed without warranty of any kind, either expressed or implied. The responsibility for the interpretation and use of the material lies with the reader. In no event shall the World Health Organization be liable for damages arising from its use.