It iscommon to find in most health facilities in Ghana computing equipment, servers,imaging and printing system, databases, communication and Internet servicesystems running independent of each other. The existing information systeminfrastructure of these facilities are not integrated, thus operate asindependent monolithic silos, denying the entire infrastructure the benefit ofdata sharing, concurrency, distribution, and fault tolerance. When systems are integrated,it guarantees heterogeneous fusion of independent silos which provides a commonplatform for applications with different access procedures, data formats andprotocols to share resources and communicate effectively. A number of thesehealth facilities are not networked in a way that supports quality healthcarepractice internally or externally. Even at facilities where local area network(LAN) infrastructure exists, it has been reduced to only surfing the web oroperations at the front office. In situations where a health facility’s LAN infrastructureis said to be utilized, then it is assisting in the provision of the following;registration and record keeping of patients at the OPD, keeping track ofsupplies at stores, automation of pharmaceutical services, managing consultationsand review of reminders. “There is currently no operational e-healtharchitecture for medical system provision in Ghana.” (National E-HealthStrategy, 2010, p.
27).The onlyintegrated national health system for health data reporting is the DistrictHealth Information System (DHIS). The DHIS has been designed and deployed forcapturing routine data, a quarterly TB data and a client satisfactory surveydata at the district level. Theministry of health (MOH) is developing an E-health application and hope to deployit all over the country when completed with the aim of providing patients,health practitioners, researchers and students, with requisite access to healthrelated information based on need to know. Thegovernment is in collaboration with association of mission health institutions,quasi government institutions, private health institution, and non-governmentalorganizations to develop the framework and institutionalization of theinfrastructure. The platform is expected to deliver all types of healthinformation, including but not limited to: Preventive health; Environmental Sanitation;Maternal and Reproductive health; Child health; Malaria; HIV/AIDS;Tuberculosis; Nutrition; Youth health issues; Insurance Issues; TraditionalMedicine; Drug Information.
This delay with a national health infrastructurenotwithstanding, a couple of mobile health interventions are currently ongoingin various parts of the country to augment the effort of the Ghana Health Servicein expanding access to healthcare. The past few years has seen the use of mobileplatforms in Ghana for a variety of purposes, ranging from personalcommunication to health Information technology infrastructure. The applicationof mobile technology in health has been increasing steadily in Ghana. There areseveral ongoing projects in the health sector sponsored by private andnon-governmental organization where mobile devices are used for activities suchas: data gathering, disease surveillance, facility supervision, and drugadherence promotion.
Others activitiesperformed using the mobile devices are immunization and antenatal/ postnatal follow-ups,and health facilities stocks monitoring. The commonmobile devices that are used for these activities include smart phones, pocketdigital assistants and simple cell phones. The earlier phones that were usedfor these activities were simple cell phones and could only access calls andSMS messages. At the time the services provided by mobile telecom serviceproviders could not support internet access, video calls and mobile TV. Withthe recent introduction of 3rd Generational (3G) Network technology by thenetwork companies, a myriad of digital devices with 3G compliant platforms arethose that are used for health data collection, analysis, anddissemination.
Currentlythere are six mHealth projects ongoing in Ghana for different aspects of healthdelivery. They are Motech, SMS for Life, EWS, Sene, Millennium development andUSAID Deliver mHealth project. 18.104.22.168 Mobile Technology for Health(MOTECH) MOTECH isan initiative of the Ghana Health Service and the Grameen Foundation, ColumbiaUniversity’s Mailman School of Public Health. It was funded by the Bill and Melinda Gates foundation. The aim ofthe project is to improve the quality of data collection on antenatal andneonatal care provided by community health attendants in the rural areas by theuse of available mobile devices.
The MOTECHprogram is in two forms, one for expectant and new mothers, and the other fornurses to manage patients’ data. MOTECH has also developed another runningprogram known as the Mobile Midwife. The Mobile Midwife Initiative is aninnovative program which provides expecting or new mothers with accuratematernal health education and reminders in the form of text or voice messagesfor upcoming clinic checkups for themselves or their babies. The nursingcomponent enables direct entry of patient visits and review information ontothe mobile phones of the nurses. The nurses use this information in generatingaccurate monthly reports which improves their efficiency and saves time. MOTECH usesa Java 2 Platform Micro Edition as the software for data capture and storage.The data when gathered is then transmitted by the help of a GPRS to acentralized server operated by MOTECH.
On the server is an electronic medicalrecords management system that analyzes the data against proper care procedureand also determines dates for review visits. Monthly reports can also begenerated from the data submitted by individual nurses (Grameen Foundation,2010). MOTECH currently operates in four regions in Ghana, namely; GreaterAccra, Central, Volta, and Upper East. It has about 66,000 registrants, beingmainly expectant and new mothers and 40, 000 mobile midwife enrollees on itsplatform (MOTECH, n.d).
22.214.171.124 Sene District PDA Project In the 2004, the Berekum Health Directorate incollaboration with Access to Health, an NGO based in the United States ofAmerica launched what is currently known as the Sene District PDA project. TheSene District PDA project uses pocket digital assistance to improve servicedelivery at the lowest level of health delivery.
It the foremost mobile healthproject in the Ghana Health Service to assist practitioners in the CommunityBased Health Planning and Services (CHIPS) compounds, which is at the lowestlevel of health service delivery in Ghana (Access to Health, 2009). . Objectivesof the project are: a. To generate reports that is accurateand timely for effective decision making by the community health officers andthe district health management team. b. To use emerging and appropriate mobiletechnology available to reduce the time Health Officersspend to generate monthly report on services they provide to the communities.
c. To improve the follow up of childrenand mothers for certain health services. d. To reduce the rate at which mothers andchildren drop- out for immunization and safe motherhood servicesrespectively. Theclients’ data are collected with the use of a PDA device running on a javaplatform. 1.
5.1.3 Millennium VillageProject TheMillennium Village project in Ghana is a mHealth project which is beingimplemented in Amansie West District in the Ashanti Region.
Villagesthat benefit from the project are selected by development agencies to receiveassistance in reaching the Millennium Development Goals and transforming thelives of over 30,000 inhabitants out of poverty. Bonsaaso isone of the towns that has benefited from this assistance and since 2006,Bonsaaso’s schools and health clinics have seen major improvement in the area of new school buildings,rehabilitation of old facilities, and the supply of medical equipment andservices to community. There wasalso a provision of an ambulance service facility by the development partnersto Tonto Krom, a neighboring town, about 12 km to the nearest districthospital. Despite theprovision of ambulance service to the community, maternal deaths in thecommunity did not reduce, because there was not any effective means ofcommunication between the locals and the health facilities for timely medicalassistance to be provided in the event of an emergency. Mobilephone manufacture, Ericson and Ghanaian Telecommunications service provider,Zain, developed an IT solution to the communication problem in 2006. This theydid by making internet service available to the villages and also providingthem with low cost mobile handset. This facility was to enable the locals toovercome their communication nightmares and to establish reliable and costeffective contact to health services providers, when the need arises. Thehealth services providers were given free handsets while the locals werecharged US$10 for each.
In theevent of an emergency, the locals call the help line at the health facility,and the ambulance is quickly dispatched to the location to bring the patient tothe hospital. A bed is then prepared in advance to receive the patient. Since theintroduction of these combine interventions in Bonsaaso, the UN says maternalhealth indicators have improved and this they say is a result of improvedprimary healthcare services.
It is evidently clear that this success canlargely be attributed to the telecommunication solution which gave the localsthe ability to report cases in time for the appropriate intervention to bereceived (Millennium Village Project, 2009). 1.5.
1.4 USAID-Deliver Project The USAIDDeliver Project in collaboration with the President’s Malaria Initiative andthe NationalMalaria Control Program developed a project which aimed at using a software tocollect data and generate quarterly reports on malaria logistics that are sentto the regions. This project is achieved through the use of Episurveyor; amobile phone survey software with functionalities which allows for efficient datacollection and analysis (USAID|DELIVER Project Bulletin, 2009). Thisproject has been ongoing since July 2009. 1.
5.1.5 EarlyWarning System The EarlyWarning System is a USAID sponsored project which is being piloted in threeregions namely; Greater Accra, Western and Central. This pilot is currentlytaking place in six district from the three regions mentioned, with the purposeof using mobile phones to collect data on health commodities from the districtsand send SMS to a centralized logistics management system. The Early WarningSystem (EWS) facilitates data collection from service points through an SMSmessage from facility workers’ personal mobile phones. The messages are thenforwarded to a toll-free short code registered with each of the mobile serviceproviders in the country.
These messages are finally routed to the centrallocal server for analysis and appropriate intervention. The mainobjectives of the Early Warning System are to provide near real-timeinformation on status of health commodities that are provided by serviceproviders to decision-makers at all levels of the service structure andreinforce the availability of all essential health commodities by improving thetimeliness and accuracy of paper-based ordering and reporting from the lowerlevel of service provision. The systemis design to involve the regional medical stores, district directorates andhealth facilities, to ensure better coordination among the various levels ofhealth commodity distribution. The systemwill also enable managers of the system to accurately calculate the facilitiesmonthly stock and average monthly consumption and stock status. The systemas an inbuilt reorder level flag which automatically triggers an effect andsends an SMS message to the district, regional, and national pharmaceuticalstores in that order for supply to carried out. 1.5.
1.6 SMSfor Life Logistic Management Thisproject is yet to be implemented in Ghana. It is similar to USAID Deliverproject. It will be implemented as a pilot project in six districts in threeregions, Brong Ahafo, Upper East, and Greater Accra Region. The aim of SMS forLife project is to provide visibility of anti-malarial stock levels to supportmore efficient and reliable stock management using available SMS technology,using a public, private partnership model that works effectively. The SMS forLife project is believed to have the potential to alleviate restrictedavailability of anti-malarial drugs or other medicines in rural orunder-resourced areas (Barrington, Wereko-Brobby, Ward, Mwafongo,and Kungulwe, 2010). Theseprojects show that mobile devices can be used for the following: a. Health service delivery.
b. Epidemic monitoring and diseasesurveillance c. Ensuring follow-ups and minimizingdrop-out rate d. Report generation. All thesesix above projects are geared toward the attainment of the millenniumdevelopment goals on health which are listed below. MDG 4:Reduce child mortality: Reduce by two-thirds, between 1990 and 2015, the under-five mortality. MDG 5:Improve maternal health: Reduce by three-quarters, between 1990 and 2015, thematernal mortality ratio.
MDG 6:Combat HIV/AIDS, malaria, and other diseases: Have halted by 2015 and begun toreverse the spread of HIV/AIDS; have halted by 2015 and begun to reverse theincidence of malaria and other major diseases (Ghana Health Service,2011). The MOTECHplatform will be used for this study. 1.5.2.Ghana E-Health Strategy SincemHealth technology is believed to provide opportunities for individuals,healthcare practitioners and providers to access information and share withrelevant service points thereby offering efficient healthcare support to thecitizenry, the Ghana E-Health Strategy outlines a number of benefits that itseeks to achieve through comprehensive eHealth architecture.
The benefits areas follows: • Improved accessibility andavailability of quality healthcare services to underserved communities through resourcesharing among primary, secondary and tertiary healthcare providers • Improved quality of care andtreatment by reducing the queuing time for patients to receive care andresponse time for medical practitioners to offer care. This positively affectsthe health outcome of the patient. • Improved monitoring of stocks andsupplies of medical and non-medical item due to an enhanced integration ofstakeholder systems within the supplier chain. • Provides a platform for eLearning tobe done from remote locations, thereby promoting continuous academicdevelopment. • Improved credibility in thegathering, interpretation and dissemination of data for both healthcare andnon-healthcare decision making. 1.
5.3.Prospects of mHealthThe role ofmHealth in disease management and access to care provision cannot be overemphasized. Mobile devices with inbuiltgeographic positioning components, can serve as tools to enable the location ofpatients in emergency situation. MHealth systems can also assist in epidemicmonitoring and disease surveillance. MHealth platforms can also be used to monitor and assist clients withchronic diseases and facilitate medication adherence.
Managers can also use mHealth tools toimprove monitoring, coordination and assessing feedbacks as well as improve onthe efficiency of the health facilities. MHealth systems can also facilitatefinancial accountability on the part of managers and cost reduction of servicesdelivered to patients. Theeffectiveness of any of these devices in improving the health status of patients and meeting thegoals of service providers is a function of the type of application, the targetpopulation, and the type of care rendered (Gagnon et al.
, 2005; Whetton,2005).