The Special Olympics Healthy Athletes program has been offering free health screenings and education to Special Olympics athletes for more than 20 years. During that time the organization has aggregated an immense and unique data set about the athletes which compete at their events globally. However, this data has been accrued as a series of health visits, each collecting specific data elements on a form. Special Olympics and VecnaCares are transitioning this data collection and storage system to a longitudinal health record, transforming individual screening data into a patient record in a custom-built system built using OpenMRS. The system is designed with accepted global best practices of data information exchange including the use of HL7 and FHIR protocols to standardize the data schema to integrate with existing systems. This session will identify key challenges to scaling a digital health system to a global deployment, and discuss lessons learned when transitioning from a single-visit system to a longitudinal health record.

Typically during the price estimation stage for global health supply chain initiatives, often there are many unknown variables that are needed for the estimation of freight costs for various shipping legs and lanes. These unknowns often drive poor price estimates which can lead to budget overruns later in the supply chain process. As these overruns can be more costly at a later point, this can lead to less funding available for additional global health-related product procurement/distribution, reducing the overall effectiveness of global health initiatives including a reduction in the number of lives saved. To address this issue, PFSCM developed and implemented a predictive modeling initiative through the use of historical supply chain data in a data warehouse, Python programming language and various stats and visualization libraries from Anaconda package manager and the Integrated Development Environment, Jupyter Notebook, and reporting and visualization through Microsoft Power BI. Through a process of objective definition, data gathering and treatment, integrated data modeling and visualization, PFSCM developed a regularly updated, user friendly, predictive modeling tool for staff involved with freight cost estimation. This initiative has saved time, reduced estimation uncertainty and improved budgeting, leading to improved supply chain effectiveness and reach.

The main objective of this poster session will be to show how the “Be Data Driven” principle from the Principles of Digital Development was a key central strategy used for the conceptualization and development of the integrated information system for the monitoring of the contraceptive insurance in Guatemala. In Guatemala, there was the need to have an integrated system to visualize data and provide easy understanding and decision-support related to the delivery and benefits of contraceptive commodities, with the special consideration that the delivery of contraceptives is done by four institutions that form a commission. For the design of the system, the use of a data-driven approach was applied such that the design, technical and technological decisions for the system were made with the users with a focus on how data would be used to improve policy-making decisions. Among the lessons learned were that governance was a key issue to promote conversation and understanding among stakeholders. Also, an iterative and collaborative process with the user is essential to ensure that data is displayed correctly and that can support the decision-making process. The information system collects data from four institutions and provides dashboards with information that is easy to interpret for actions to be taken by the commission.

The Integrated Management of Childhood Illnesses (IMCI) strategy was developed by the World Health Organization (WHO) to reduce morbidity and mortality among under-five children across the globe. Among its core components is enhancing case management skills of frontline health workers (FHWs): IMCI prescribes a series of steps to FHWs to identify and manage major childhood diseases. IMCI implementation has traditionally relied on paper-based tools and training material, which creates the need for memorization and lengthy training sessions, along with heightening chances of error and prolonging screening time per child. As a result, IMCI implementation has faced persistent barriers, and impact has been limited. Using Android technology, we developed eIMCI, an electronic version of WHO’s 2014 IMCI guidelines. The application allows FHWs to easily navigate the otherwise complex IMCI protocol on their mobile phones, eliminating the need for memorization and extensive training. As data is entered into the application, the system automatically integrates incoming patient data with disease symptoms to classify the patient in accordance with IMCI algorithms, and enables the FHW to skip over questions that are irrelevant to the case at hand. Screening time per child is thus considerably reduced. Furthermore, the application incorporates a referral system whereby FHWs can connect more serious cases to a health facility for treatment and follow-up. In our session, we will demonstrate how eIMCI works, and invite the audience to explore the application on a mobile device. Screenshots from the eIMCI application will be displayed on our poster, along with quotes from FHWs who have used the application. We will discuss the various stages the project went through before being scaled up and deployed at Indus Hospital in Karachi, Paksitan, where more than 80,000 children have been screened through eIMCI till date.

The rapid and vast proliferation of mobile technology has revolutionized the ability of health systems to achieve better outcomes, including improved geographic monitoring of immunization services. Expanded access to new technologies including Global Information System (GIS), and online mapping tools (e.g. Google Maps) has enabled more detailed maps and satellite images for demarcation and identification of priority areas during routine and large-scale mass immunization activities. We have leveraged these technologies to deploy a unique, cost-efficient and powerful tool for monitoring workforce and undertaking assessments of geographic coverage of immunization services. This session will outline our experience of piloting and scaling up a GSM-based Geographic Information Systems (GIS) tracking service in a low middle income setting. We will elaborate upon our experiences of piloting the technology in 2013, across 2 rural districts in Sindh province, Pakistan, tracking 20 vaccinators during a polio supplementary immunization campaign for 3 days. We will highlight the tracking mechanism and the positive results (in terms of improved attendance and geographic mobility of vaccinators) that enabled us to garner support from the Government and GAVI, for eventual scale-up of the system in 2016. Currently, the system is being used to track over 2000 government vaccinators, linked to 1,138 health facilities across 27 districts of the province. In addition to explaining the processes leading to scale-up, we will also highlight the advantages of the GSM tracking over GPS technology including the ability to track through regular mobile SIMS, no requirement for data connectivity or smartphones and preservation of phone battery life. The session will also highlight the impact and how real time tracking information is converted to actionable data for supervisors, ensuring effective monitoring and coverage of all target areas, specifically remote geographical pockets that remain unreached by immunization services.

This session will highlight PATH’s experience using digital technologies to address the TB epidemic in Tanzania, Ukraine, and India and will provide evidence and insights to inform global policy and enable further technology improvement and innovation. For Tanzania, we will present TAMBUA TB app’s two modules. One module increases public awareness of TB and allows anyone with a basic mobile phone to self-screen for TB symptoms by answering a series of questions. From September 2018 to April 2019, 229,898 individuals self-screened, and 166,758 self-reported as presumptive. The second module provides TB patients treatment adherence support by sending SMS reminders and messages based on their treatment schedule. Health care workers (HCWs) enroll patients in the service, which simultaneously enrolls patients in the national TB registry, demonstrating how building off existing government technology can improve HCW workload efficiency. In Ukraine, PATH supports TB patients to increase treatment completion rates with two distinct digital interventions—“medication event reminder boxes” and video technology to 1) reduce patients’ need to visit clinics in person and 2) reduce HCW workload and health care system costs while enhancing patients’ autonomy and decreasing stigma. With the boxes, patients receive alerts and are monitored remotely by HCWs through an online dashboard when the box is opened to retrieve medication. With video technology, an HCW observes the patient taking their medication regardless of where the patient is. In India, PATH is piloting artificial intelligence to increase efficiency of TB screening using Qure.ai to detect abnormal chest X-rays and refer them to professional radiologists for further analysis. This process helps reduce HCW workload and reduces need for TB diagnostics at lower levels of the health care system. It also helps people receive a faster TB diagnosis and initiate treatment quickly so they are less likely to transmit TB.

• Newborn deaths remain unacceptably high in low-income countries despite increased emphasis on newborn resuscitation. Fetal outcomes can be significantly improved by the use of fetal monitoring during labor and delivery, however this requires sophisticated analysis of fetal heart activity patterns. This is done routinely in high income countries, but is often too expensive for use in low-income countries. Through funding from a Saving Lives at Birth award, D-tree International developed a very low-cost device (approximately $100 compared to the traditional $2000 - $5000) that accurately monitors fetal heart activity, and is connected to a mobile solution which provides decision support to midwives based on WHO algorithms. • The tool captures and displays data on uterine contractions and fetal heart activity patterns. The analysis of fetal heart activity, including accelerations and decelerations, is consistent with globally recommended criteria for fetal distress. From February to April 2019, 28 midwives were trained and used this tool at Queen Elizabeth Central Hospital labor ward in Malawi to monitor the fetal condition for 101 women who were in labor. The device was perceived by midwives to be easy to use and provided more timely decision making. Additionally, women were satisfied with the device as it did not cause pain and allowed visualization of the fetal heart rate. • In this presentation, D-tree will share the experience of developing a low-cost fetal monitoring device and its use by midwives in monitoring women during labor in Malawi. This device has the potential to improve newborn outcomes more globally, by improving the accessibility and quality of care provided during labor and delivery. The low cost and ease of use makes it possible for use in health centers and district hospitals where deliveries are done throughout Malawi and other less developed countries.

MEASURE Evaluation has developed a One Health electronic platform in Burkina Faso, in partnership with three ministries, to track, prevent, and respond to zoonotic and epizootic disease outbreaks. Using DHIS 2 tracker, the platform does not aim to focus on data aggregation, but instead translate notified events into measurable indicators. The system allows for data from all levels of the health system to be integrated and analyzed, including data from the laboratories (sample transportation and testing), and for all players to be connected. Since this work is a collaboration between 3 ministries (Health, Livestock and Fisheries, and Environment), three DHIS 2 instances had to be created to allow them to control their own content and parameters. A fourth database was also developed with the role of automatically analyzing the data entered into the three other databases. Each ministry has actively participated in the technical development of their own platform by creating dedicated IT teams to build the platform with guidance and technical assistance from MEASURE Evaluation. The three ministerial IT teams oversee maintenance and sustainability of their respective platforms. The fourth database is managed by the technical secretariat of the One Health coordination platform with support from the One Health focal points at the three ministries. While data entry was typically done at the district level in the BF health system, One Health data is now entered at the community level by facility staff on tablets. MEASURE Evaluation is conducting a series of trainings on the One Health electronic platform to train and equip all end users. Currently, the One Health electronic platform tracks 52 human, 14 animal, and 7 environmental diseases and is interoperable with ENDOS, Burkina’s HMIS. Efforts are currently being directed at making the One Health platform interoperable with the laboratory sample information system.

MEASURE Evaluation’s technical assistance to Burkina Faso’s Ministry of Health in strengthening its routine health information systems (RHIS) began in 2018. In September 2018, MEASURE conducted a Performance of Routine Information System Management (PRISM) assessment to evaluate the strengths and weaknesses, as well as programmatic needs and challenges, of Burkina's health system. The survey targeted all levels of the health pyramid using the six revised PRISM tools developed by MEASURE Evaluation. The customized assessment was one of the first of its kind in both the sampling choices (focusing on all levels but in only one region) as well as the combinations in the uses of the tools. The evaluation was conducted in all central, regional, and district levels units of the Center-South region (MEASURE Evaluation’s zone of intervention). Stratified random sampling was used to select 16 health facilities in each of the Center South region’s four districts. Data collection methods included desk reviews, observations, interviews, and data abstraction from primary data collection and reporting tools, and RHIS databases. To check for trends in data quality, three periods were set and four indicators selected for data accuracy checks. The questionnaires were configured into an Open Data Kit platform serving as a data entry platform on Android tablets. Data were then analyzed with the PRISM Analysis Tool based on the PRISM analysis plan previously developed by MEASURE. The data analysis provides results on the performance of the RHIS in terms of quality of data (timeliness, accuracy, and completeness) and level of use of information for decision making. These results are presented by level of the health pyramid to facilitate follow-up actions. In addition, key technical, organizational, and behavioral determinants influencing the overall RHIS performance are ascertained to allow for full comprehension of the results.

MEASURE Evaluation’s technical assistance to the Cote d’Ivoire Ministry of Health in strengthening its routine health information systems (RHIS) dates back to 2004. MEASURE’s two Performance of Routine Information System Management (PRISM) assessments in 2008 and 2012 subsequently led to RHIS interventions. The 2018 PRISM assessment aimed to evaluate the improvements of the country’s RHIS and identify key challenges to address for a full functionality of the overall RHIS. The survey targeted all levels of the health pyramid using the six revised PRISM tools. The selection of sites was based on convenient and random sampling to take into account the weight of key sites such as regional and general hospitals compared to usual health facilities, as well as districts located in regional capitals vs other districts within the same region. The overall sample size encompassed 12 regions, 24 districts, and 235 health facilities including regional and general hospitals as well as urban and rural health centers. Data collection methods included desk reviews, observations, interviews, and data abstraction from primary data collection and reporting tools, and RHIS databases. To check for trends in data quality, three periods were set and four indicators selected for data accuracy checks. The questionnaires were configured into an Open Data Kit platform serving as a data entry platform on Android tablets. Data were then analyzed with the PRISM Analysis Tool based on the PRISM analysis plan previously developed by MEASURE. The data analysis provides results on the performance of the RHIS in terms of quality of data (timeliness, accuracy, and completeness) and use of information for decision making. These results are presented by level of the health pyramid to facilitate follow-up actions. In addition, key technical, organizational, and behavioral determinants influencing the overall RHIS performance are ascertained to allow for full comprehension of the results.

Following a routine health information system (RHIS) performance assessment in 2015, MEASURE Evaluation started working in Mali to reinforce its local health information system (SLIS) and hospital information system (SIH). The 2018 Performance of Routine Information System Management (PRISM) evaluation aimed to assess improvements in the SLIS while identifying key determinants influencing performance, and establish a baseline information for the SIH. The survey targeted all levels of the health pyramid using the six revised PRISM tools. The selection of sites for the SLIS was based on convenient and random sampling taking into account the weight of key sites (reference health centers vs. usual health facilities), as well as districts located in regional capitals compared to other districts within the same region. The overall sample size was represented by 8 regions, 14 districts, and 153 health facilities, including the whole universe of hospitals. Data collection methods included desk reviews, observations, interviews, and data abstraction from primary data collection and reporting tools as well as the RHIS database. To check for trends in data quality, three periods were set. Four indicators were selected for the SLIS and six for the SIH. The questionnaires were configured in the Open Data Kit platform for both systems using Android tablets. Entered data were then analyzed separately with the PRISM Analysis Tool based on the PRISM analysis plan previously developed by MEASURE Evaluation. The data analysis provides results on the performance of the RHIS for both the SLIS and SIH in terms of data quality (timeliness, accuracy, and completeness), and level of use of information for decision making. These results are presented by level of the health pyramid to facilitate follow-up actions. In addition, key technical, organizational, and behavioral determinants influencing the overall RHIS performance are ascertained to allow for full comprehension of the results.

As more organisations begin scaling digital health interventions, it is increasingly important for us as a community to share not just successes, but also lessons learned and ongoing challenges. Over the last 18 months, Marie Stopes International has been developing, maintaining, and embedding a mobile data collection app to frontline family planning providers in 11 countries across Asia and Africa that helps providers deliver family planning and other SRH services. This session will present MSI’s development and implementation journey, and will draw on that experience to provide health organisations with potential tools, processes, and frameworks to use when scaling a digital health intervention in multiple countries. Because MSI has deployed a distinctive linked-application set-up using Dimagi’s CommCare mobile data collection platform, we will focus particularly on the advantages and lessons learned of scaling a single global application (with localisations) across multiple country contexts. The presentation will span three categories: application management, application deployment and scale-up, and application embedding, and will conclude with a discussion of our ongoing challenges, which we hope will spark further conversation on the topic.

In collaboration with the Maine Medical Center and Ocean Road Cancer Institute in Dar es Salaam, Tanzania, Dimagi has developed mobile-Palliative Care Link (mPCL), a novel mobile application to improve symptom control and information exchange among specialists and local health workers treating late-stage cancer patients, the first digital health app in Tanzania to address palliative cancer care. The African Palliative Care Association Palliative Care Outcome Scale (APCA POS), a validated symptom control assessment to better manage patient symptoms and needs, was adapted for mobile delivery and symptom control management by nurses, oncology specialists and local health workers (LHWs) using a user-centered design framework. The mPCL application is a patient- and provider-facing application built on Dimagi’s CommCare platform. mPCL supports the entry of POS responses by patients or caregivers, facilitating timely review and tracking of patient responses and care information, and enabling more supportive follow up by specialists and local health workers. Preliminary results from a pilot study with patients served by LHWs in and around Dar es Salaam show high user acceptance and engagement, with patient and caregiver feedback indicating interest in expanding the scale and scope of the system. The design of mPCL and supporting feedback and usage data collected from end users offer insight and learnings that can inform the development and adoption of mobile tools designed to improve patient care in palliative care settings as well as the management of other noncommunicable diseases in low resourced areas.

Maintaining HIV patients on treatment is vital to bringing the disease into epidemic control and achieving “90-90-90”- the global objective of 90% of HIV+ individuals aware of their status, 90% of diagnosed patients on sustained treatment and 90% of treated patients achieving viral suppression. In South Africa only 74% of patients who are aware of their status are currently on treatment (Thembisa 4, SA AIDS Conference). Those that drop out, in addition to having poor health outcomes, increase the risk of viral transmission. Addressing patient retention is therefore critical to achieving HIV epidemic control. The challenge is magnified in an environment of underprivileged patients in resource-constrained public health systems. Many promising interventions to increase patient ongoing engagement in HIV treatment are hampered by health care worker capacity constraints. Meanwhile, scalable digital technologies that have been deployed elsewhere to promote adherence through direct patient engagement remain out of reach, exacerbated by low connectivity and underdeveloped data privacy policies. BroadReach is tackling the critical challenge through application of leading edge technology in the form of predictive modelling. Predictive modelling bridges the gap between the need and the available resources by empowering health care workers with insight into which patients are most at risk of dropout as early as possible in their treatment journey. Health workers can prioritize the “last mile” connection to the most vulnerable patients through focused interventions available in their environment, improving outcomes for both the individual and his or her community. BroadReach’s panel presentation demonstrates how predictive analytics modelling is used to establish risk and then, how pragmatically this information can be used in a live setting to catalyze targeted interventions that increase treatment retention among HIV patients, accelerating health system performance towards epidemic control.

• The Mobile Alliance for Maternal Action (MAMA), a global consortium with public-private funding, has delivered vital health information to pregnant women, new mothers and their families through SMS text messages and interactive voice calls (IVR) using their mobile phones their mobile phones with messages that are specifically designed for behavior change. Through an “ages and stages” model, the messages correspond to what a woman is experiencing in her pregnancy or in her child’s development, creating a trusting relationship between the end user and the MAMA Service. With an intentional focus on countries where high maternal and newborn mortality rates intersect with an increasing proliferation of mobile phones, MAMA directly supported country programs in Bangladesh, India, and South Africa and in 2015, launched a program in Nigeria, branded as HelloMama. The HelloMama project operated in Nigeria with the goal to improve the health outcomes and quality of life for pregnant women, newborns, children and their families through a nationally scaled, locally led, and universally accessible demand generation service. HelloMama’s theory of change is based on evidence that when a woman has appropriate information about her health, her child’s health and services that she should use, then she is more likely to adopt health behaviors and use services that will lead to improved health outcomes

How might we engage providers in capacity-building and engagement in supporting transgender and/or non-conforming people in healthcare systems globally? transCONNECT is a social franchising program and digital education platform offering HIV care providers capacity and competence in caring for transgender and non-binary (TGNB) patients. transCONNECT offers providers education on transgender and non-binary gender identities, cultural humility, trans & non-binary experiences in healthcare settings, HIV care and prevention, and best practices when working with marginalized identities. Developed as a digital education tool using the human-centered design process, transCONNECT offers a flexible learning opportunity for a variety of learning types that is accessible to providers with varying knowledge of TGNB care, and access to digital learning platforms. Supported by a social franchising network of brand and training, transCONNECT offers consistency and empowerment to connect inclusive providers with their local TGNB communities. Incorporating technology into the framework of continuing education, particularly for engaging providers in trans-competent and inclusive care, is essential. After initial access, the training tool allows access to content when offline. In an effort to normalize and expand gender care globally, the platform will offer the opportunity to customize, access, and educate providers to support marginalized gender identities from all over the world, in a variety of settings and time zones. Supported by social franchising, the transCONNECT program will disrupt global provider educational inequities or gaps in knowledge; from the healthcare worker in the field to the physician in a hospital. The YTH team will share the evaluation results of the pilot study to be conducted from May-July 2019, where we expect to showcase findings and lessons learned, as well as a review of the human-centered design process and development of the social franchising program in the context of trans-inclusive care.

In 2017 Jhpiego, a Johns Hopkins University affiliate, partnered with the Ministry of Health, Community Development, Gender, Elderly and Children -Tanzania Mainland and the Ministry of Health Zanzibar to implement the USAID Boresha Afya project in Tanzania’s Lake and Western Zone. Jhpiego implemented Open Smart Register Platform (OpenSRP) in line with the government of Tanzania choice as the digital health platform for Community Health Workers (CHWs). OpenSRP is an open source mobile health platform developed for frontline health workers which encompasses CHWs and Facility Health Workers (FHW) that allows them to register their clients and track their health services across continuum of care. The mobile application implemented and completed in Lake and Western Zone in 2019 has been used to address Reproductive, Maternal, Newborn and Child Health (RMNCH) and Malaria challenges including strengthening referral system from community to facility and inter-facilities and closing the gap between health facilities, community health workers and clients thus improving primary health care service delivery, strengthening accountability, aid in decision-making, and generate real-time data for improved monitoring and evaluation. Using OpenSRP, CHWs were able to: register all family members, children under 5; associate the family with a GPS location; view services that are due, and make referrals as required; record key recent health facility services; ask the caregiver questions and monitor children for danger signs; record any health facility services provided; record malaria diagnosis and the treatment provided; receive a notification for follow-up after the client returns to their home etc. Clients were also able to message project phone numbers triggering emergency notifications to the CHW and HFW as well as call a driver for transport or a health facility to help coordinate transport.

‘Online SBCC Materials Approval (OSMA)’ is an online software application(http://osma.mohfw.gov.bd) designed to digitize and simplify the activities of the IEC Technical Committee constituted for approval of quality HPN SBCC materials assuring the compatibility of policy and social values, informative statements and acceptability under the 4th HPNSP of the Ministry of Health and Family Welfare (MoHFW), prepared for strengthening the awareness program, aimed at changing the health-related behavior of the community. The application has been developed to enable IEC Technical Committee to receive, review and approve SBCC materials in a systematic digital process. Due to this application, IEC Technical Committee as well as the applicants, like directorates and units under MoHFW and NGOs, will be able to save time and resources that is spent on getting a material approved. This application ensures the highest quality SBCC materials are approved and avoid duplication of materials. The application preserves the approved SBCC materials in digital form and develops regular updating of information on HPN SBCC materials production and dissemination. As part of USAID-Ujjiban SBCC project’s role for capacity and system strengthening of MoHFW and following the Comprehensive SBCC Strategy, Ujjiban has developed this system to overcome the challenges of the manual procedure and brings about an automated and effective mechanism for GoB and NGOs. Primarily this digital platform for submission, recommendation and approval of SBCC materials has considered the MoHFW and NGO applicants’ requirements and tested the interface to upgrade navigation and make it user-friendly. Security issues and issues related to uploading the application to the DG-MIS server were also resolved in this stage. In the second stage an archive for revised and approved SBCC materials, and reports was developed. In addition to archiving meeting minutes and materials, the archival feature stores complete information about materials and reports.

Helping Babies Breathe (HBB) is a neonatal resuscitation training and educational program which has rolled out in 80+ low/middle-income countries (LMICs). From 2012 - present, a multi-disciplinary team of investigators from Indiana and Moi Universities, in collaboration with key partners, has developed various iterations of a mobile phone app to support implementation of HBB programs in LMICs. Seven members of our Indianapolis-based team performed a contextual analysis to better understand existing gaps and barriers faced by providers and supervisors in LMICs, and to map the existing mHealth ecosystem within East Africa. Then, using open-source tools, principles of user-centered design, and agile development processes, including weekly scrum meetings, our team employed four subsequent app development phases to develop and test an Android app (mobile Helping Babies Survive powered by DHIS2; mHBS/DHIS2) that can be utilized by HBB Mentors, Supervisors, Facilitators, and Providers for a wide variety of functions. mHBS is integrated with DHIS2, a health management information system platform that is utilized by many of the same countries in which HBB has reached national scale-up. Field testing is on-going in Kenya and Nigeria; a total of 12 educational evaluation, data collection, and reporting tools are available in mHBS/DHIS2. Permissions can be set in the app to allow for either identified (e.g., by name), or de-identified (e.g., by pin code) self-directed learning, and/or for HBB implementors with various roles to administer the evaluations to others, either as Facilitators, before/after a course, during quality improvement exercises, or by Providers during peer-learning. Scoring is automated, and "pass"/"fail" messages, as well as guided debriefing sequences, are fully customizable. Upon submission to the mHBS/DHIS2 server, evaluation forms are no longer editable -- providing a digital record of the progression of learning, skills, and competencies among trainees.

There is a distinct lack of private health sector data availability in Tanzania. In order for the government to make fully informed decisions about commodities and services, both public and private sector contributions need to be considered. Private sector data is integral to programming and decision making; for example, allowing government programs to make high-level decisions about commodities using the data. Accredited Drug Dispensing Outlets (ADDOs) are small, privately-owned drug shops that are an essential source of care and commodities for Tanzanians living in rural and remote areas. However, for last mile health platforms like ADDOs, sharing data can be a challenge. In 2019, the Sustaining Health Outcomes through the Private Sector (SHOPS) Plus project in Tanzania partnered with the Clinton Health Access Initiative (CHAI) to support their unstructured supplementary service data (USSD) mobile reporting platform. USSD enables ADDOs to directly report malaria, pneumonia, and child health service and commodity indicators into DHIS2. Working with government stakeholders and CHAI, SHOPS Plus amplified the ADDOs reporting capacity by providing virtual support to them, co-leading trainings, and expanding the DHIS2 platform to include family planning indicators. The poster will share insights from activity implementation including how to successfully and sustainably engage low-level providers and increase the visibility of their contributions to healthcare systems. The poster will also demonstrate how mobile phones can be used to make commodity and service data from last mile health platforms available for use local, district, and national level decision making.

In 2018- mid 2019, Viamo worked with the Ministry of Health/Rwanda Biomedical Centre and a multinational private pharmaceutical company on an innovative remote training strategy using simple mobile phones that are readily accessible to Community Health Workers. Viamo delivered remote training in the form of a four-week curriculum on mental health issues to 55,000+ community health workers in Rwanda using Interactive Voice Responses (IVR). IVR comprises automated voice messages delivered straight to the CHWs’ own mobile phone in the form of a pre-recorded voice call. The curriculum was a combination of interactive voice messages and comprehension quizzes. The intended outcome of the project was that CHWs would have an increased understanding of what constitutes a mental health issue, different types of common disorders, causes and how they can best support people in their communities suffering from mental illness. The project would additionally increase CHWs' confidence to correctly identify a person suffering from mental illness, refer them to hospitals and educate other community members on mental illnesses in the lead up to the anniversary of the Rwandan genocide. Viamo proposes a panel presentation to share how this innovative training method was created, the initial results of the project, and the implications for remote training in the future. Viamo's goal is to avoid "hit and run" workshops with no follow-up or in-field mentoring by developing mobile curriculums co-designed to fit the goals of in-person training. At this presentation, Viamo will announce training results and data, including initial findings that show mobile training supports peer to peer informal learning, and share our recommendations for data collection for program evaluation.

Delays to access health services the major challenge for towards institutional delivery in most isolated villages. Other delays are identified as decision making on accessing health service, distances and infrastructures from community to facilities as well as health services provision at the facility. Ministry of health has set a facility target to reach a certain number monthly facility deliveries from the number of expected pregnant women around catchment areas. Every pregnant woman is supposed to deliver at the facility. For better implementations of maternal and new born health, evidenced based interventions are highly emphasized. USAID Boresha Afya projects has been using GIS and spatial analysis in daily data use approaches to identify and map out the pregnant women attending the clinic and the distance to that nearest health facility. These heat maps assist community health workers to closely follow up making sure all pregnant women are visited and provided health education on the importance of giving birth at the health facility. With the geospatial analysed maps, CHWs and HCWs have been able to notice which places are populated, where are women of reproductive age scattered and hence easy household visits for health education provision and registering and referring of new pregnant women to attend the clinic. Maps created from the layers of population density with expected pregnant women and available services in nearest health facilities gives a strong evidence of unreached women of reproductive ages who have no access to timely services provision hence delays to access the facility during labour and delivery period. And this is crucial in the reduction of home deliveries as well as maternal and new born deaths. CHWs around the highly populated area are provided a household targets for all the pregnant women to be visited or escorted during labour period to avoid delays mentioned.

Despite relative success of the Malawi immunization program, Save the Children in collaboration with the Expanded Programme of Immunisation (EPI) Unit and Integrated Management of Childhood Illnesses (IMCI) Unit of the Ministry of Health, identified low visibility of EPI logistics data and a lack of consistent procedures for reporting and resupplying EPI products. This situation often leads to interrupted vaccination services in some parts of the country and eventually leads to poor performances of the EPI system. Responding to challenges, Ministry of Health with support from Save the Children, piloted EPI cStock intervention to address these challenges in Neno and Thyolo (Southern Malawi). The end-line survey for piloted districts showed improvement in stock levels of vaccines with 100 % facilities reporting having all vaccines compared to 71% with BCG, 79% with Polio and 79% with measles vaccines at baseline. Additionally, at baseline 24 % of facilities in Neno and 19 % in Thyolo showed problems in timeliness of reporting with 100% at end line. Compared to the baseline, the end-line survey showed improvement in availability of EPI products from 78% to 100% on fridge tags and from 50% to 100% on fridge thermometer. These findings influenced the scaling up of services to other two more districts. Comparing reporting rates and completeness for EPI cStock with Integrated Community Case Management (ICCM) for newly scaled up districts, EPI cStock reporting rates (75% on average) and completeness (73 % on average) for report submitted are better than those of ICCM (22% and 24%) for the same facilities. This presentation gives a highlight and demonstrates how data from pilot project was used to influence scaling up, the process undertaken and how 9 principals of developing digital health were applied during scaling up. Furthermore, data from the scaled up facilities will be presented.

mBrana, a locally developed mobile stock management tool, has already been deployed in Ethiopia for vaccine management at districts (in nearly 800 districts as of June 2019) by the Federal Ministry of Health and the Ethiopian Pharmaceuticals Supply Agency with the support of John Snow Inc. The system allows for seamless supply chain management including electronic ordering, and is interoperable with higher level stock management systems (central and regional/hub levels) to provide real time data visibility. This presentation describes a pilot to implement the system at health facility level. The pilot quantified benefits of the system and user acceptance, in order to improve system performance and help policy makers decide on the desirability of scaling the system to the more than 3,500 health facilities in the country. The existing mBrana system was modified in-country for use at health centers. In 2019, the system was deployed to seven facilities in a district in Tigray for six months with baseline data captured prior to implementation. The pilot demonstrated significant benefits: use of the standard vaccine request form improved from 48% (paper) to 100% (electronic), data quality increased from 27% to 73%, and vaccine availability from 81% to 97%. Users were generally happy with the system, and proposed some important new features for the future. The pilot provided real time data visibility down to the health facility level and electronic ordering of monthly vaccine supply from facilities to the EPSA hub. The system is still in use and stakeholders are currently considering how to expand deployment to the entire country. Having a district program head already familiar with the system to support implementation was a major facilitator for success. The presentation will provide background and contextual information, discuss how the system was deployed, results achieved, lessons learned and future recommendations for expansion.

Currently, information about immunization is collected at facility and community through two separate forms and entered separately into the national reporting platform with attendant burden for data entry and potential for double count. This two data entry and management are managed by two government organizations across all the over 36 states in Nigeria. This presents an estimated 72 different government agencies with attendant data management burden. In addition, UN agencies and Non-governmental organizations are active data management organizations. This session will present a mobile application solution for tracking immunization information of a child between a Primary Health Center and community in a given ward. This application was developed to conform to Fast Healthcare Interoperability Resource (FHIR). Participants will hear steps taken to profile the immunization registries into FHIR resource. They will also learn how the application prototype was developed and tested in preparation for piloting. Finally, participants will learn how this application is modelled to support joint data ownership and tracking through use of a Blockchain prototype.

In response to the huge maternal and newborn mortality indices, the Health and Human Services Secretariat with support of WHO set out to implement a Quality of Care (QOC) initiative for Maternal, Newborn and Child Health (MNCH). Two problems with significant outcomes were targeted namely; Administration of uterotonics within 1 minute of delivery to prevent Post-Partum Haemorrhage and ensuring immediate skin-to-skin contact to newborns for at least 1 hour after delivery to prevent hypothermia.Quality Improvement (QI) teams were set up in health facilities to develop changes around the identified problems and test them using a Plan-Do-Study-Act (PDSA) cycle over a short period. They were then required to measure their performance (process and outcome) to decide if they would adapt, adopt or abandon the changes. Implementation of the initiative was successful but the key performance indicators required for measurement of the tested changes were not available on the traditional HMIS registers which also had data quality issues. Mechanism for data use and feedback on service performance was non-existent. Facilities had no access to analyzed data and their capacity to analyze data was low. This created a unique opportunity to leverage on an electronic platform for data collection, analysis and use as well as reporting by the facilities. Data collection forms were redesigned to capture missing data fields and digitized on the electronic platform with an interface for direct real-time data entries, analysis and report generation dashboard. Daily, weekly, monthly and annual summaries can now be generated. Facility coaches can now use the platform to remotely monitor performance of the facilities before monthly coaching visits. Facilities can now generate and present data visuals (graphs, tables, maps) showing achievements toward targets, indicators, trends and situation data at quarterly peer-to-peer learning meetings.

To achieve the UNAIDS goal of 95-95-95, a novel digital health surveillance application was implemented in three northern Zambia provinces by EQUIP/Right to Care-Zambia to improve HIV testing yield. As Zambia progresses towards epidemic control, identifying ART-naïve people living with HIV that do not know their status is becoming an increasingly rare event. Emphasis has shifted to increasing testing yield through more efficient testing modalities and well-supervised counseling staff. Real-time analysis of data and program efficiency in reaching targeted individuals is paramount to controlling the HIV epidemic. EQUIP implemented the QODE Lynx HIV testing application, a mHealth solution tailored for the Zambian context, beginning in August 2018. Lynx provides real-time HIV testing data with GPS coordinates through mobile data connections and is administered by local professional and lay counselors on any Android compatible device with geolocation data. The Lynx data input process sequence guides the user through the national testing policies as ascertained through focused questionnaires. Variables collected include counselor details, client demographics, HIV test and result, risk factors, screening questions for co-morbid conditions, and referrals for clients testing negative (PrEP and VMMC) or HIV-positive (ART clinic and index contacts). Data is then instantly uploaded in real-time (or when the device is connected to mobile data) and analyzed through interactive web-based dashboards by program and M&E managers.

The session will provide an opportunity to understand KT’s innovative solutions such as a mobile-based disease surveillance and alert system, Global Epidemic Prevention Platform(GEPP) and KT’s future endeavors including AI based health monitoring and prediction systems such as Flu Tracker and Finger registration-based Vaccination System. Vice president of the KT’s Big Data Business Support Unit will provide a resourceful presentation on GEPP, including hands-on implementation experience in developing countries to testify how the solution has created impact to improve national health capacity. In addition, he will unpack comprehensive AI based digital health solutions with an implementation roadmap. Q&A session will follow to open a discussion on how to synergy with key stakeholders, including NGOs, funding agencies, and governments to benefit private sectors’ opportunities in the digital health market. In 2016 KT established GEPP with Korean Government to prevent infectious disease such as MERS-CoV which highly affected the country in 2015. GEPP is designed to assist a national quarantine system and to improve public health by monitoring infection risk and increasing awareness of at-risk nationals who visit epidemic-prone countries (and/or sub national level). In addition, the big data on at risk population and area helps national health policy formulation. In 2018 GEPP successfully addressed MERS-CoV re-oubreak. With a demonstrable impact KT is implementing GEPP in Kenya, Ghana, and Laos, which are susceptible to infections and is trying to take a step forward in national digital health arena such as mother and child health care, digital immunization record, infectious disease medical care, disease surveillance and control, digital risk reporting.

OpenLMIS is an open source electronic logistics management information system (LMIS) built to manage health commodity supply chains in low- and middle-income countries. OpenLMIS is a growing initiative to provide a full-feature electronic LMIS solution to Ministries of Health and other global partners and stakeholders to increase supply chain efficiency and data visibility. The initiative’s philosophy of promoting inclusive open-source principles, interoperability, and country ownership have guided the initiative to be recognized as a certified Global Good (*as defined by Digital Square) that is well-poised to continue transforming national supply chains around the globe. OpenLMIS has released all-new functionality within the latest release, including support for the unique needs of vaccine supply chains and health commodity kits. In addition, the latest version has released an all new analytics and big data warehouse infrastructure to support fast queries and compelling data visualizations within the system. The OpenLMIS poster will explain the background of the initiative, the nature of the OpenLMIS Community, global standards supported by the software, integrations with OpenSRP/DHIS2, the current available functionality and all-new features.

Approximately 3 million children younger than 5 years living in low- and middle-income countries (LMICs) die each year from treatable clinical conditions such as pneumonia, dehydration secondary to diarrhea, and malaria. A majority of these deaths could be prevented with early clinical assessments and appropriate therapeutic intervention. In this study, we describe the development and initial validation testing of a mobile health (mHealth) platform, MEDSINC®, designed for frontline health workers (FLWs) to perform clinical risk assessments of children aged 2–60 months. MEDSINC is a web browser–based clinical severity assessment, triage, treatment, and follow-up recommendation platform developed with physician-based Bayesian pattern recognition logic. Initial validation, usability, and acceptability testing were performed on 861 children aged between 2 and 60 months by 49 FLWs in Burkina Faso, Ecuador, and Bangladesh. MEDSINC-based clinical assessments by FLWs were independently and blindly correlated with clinical assessments by 22 local health-care professionals (LHPs). Results demonstrate that clinical assessments by FLWs using MEDSINC had a specificity correlation between 84% and 99% to LHPs, except for two outlier assessments (63% and 75%) at one study site, in which local survey prevalence data indicated that MEDSINC outperformed LHPs. In addition, MEDSINC triage recommendation distributions were highly correlated with those of LHPs, whereas usability and feasibility responses from LHP/FLW were collectively positive for ease of use, learning, and job performance. These results indicate that the MEDSINC platform could significantly increase pediatric health-care capacity in LMICs by improving FLWs’ ability to accurately assess health status and triage of children, facilitating early life-saving therapeutic interventions. (See publication in the American Journal of Tropical Medicine & Hygiene here: http://www.ajtmh.org/content/journals/10.4269/ajtmh.18-0869)

Many in the digital health field believe that metrics focused on user acquisition are sufficient for determining the success of a digital health intervention, but without active use, most of the time high sign-up or download rates mean nothing. It's tempting to broadcast a higher number, call it good, and go no further. But for Maternity Foundation, in order to bring about our desired behavior change among skilled birth attendants (to improve their skills, knowledge and confidence to correctly perform basic emergency obstetric care) we must ensure that our digital intervention, the Safe Delivery App, engages users to spend a sufficient amount of time learning from our content and features. But what kind of usage patterns and how much time can be deemed "engaged"? Engagement is a highly subjective metric, and varies from intervention to intervention. In our case, it varies from use case to use case-- the App is used both pre- and in-service training by students/ trainees and teachers/ trainers, and as a job aid. Usage patterns also vary based on geography and context. Maternity Foundation would like to share our initial thoughts and work to define engagement across these use cases, including how we have analysed the data and triangulated it with programmatic data to begin to develop user personas, and finally how we have translated these findings into changes in the content and features of the App to improve stickiness going forward, and how to use findings to inform programmatic design. We will focus on sharing challenges in data quality, in measuring offline users, in balancing ideal scenarios usage with practical realities of how people engage with digital tools.

The National Autonomous University of Mexico (UNAM) is the largest University in Latin America. The Department of Biomedical Informatics of the School of Medicine of UNAM was created on September 2010 to teach the subjects of Biomedical Informatics I and II, in the 2nd and 3rd semester of the career of Surgeon, respectively. The general objectives of these subjects are that medical students a) acquire the informational and digital health competencies necessary to practice general medicine, b) make medical decisions based on the best evidence and in critical and ethical clinical reasoning, based on the rational use of state-of-the-art technological resources. The educational model initially built its contents from the Biomedical Informatics textbook of Columbia University, International Medical Informatics Association (IMIA) and Advisory Panel for Medical Informatics of the Association of American Medical Colleges. It incorporates the student knowledge about search, selection, and recovery of biomedical information, translational medicine, hospital information systems, SADCs, telemedicine, artificial intelligence, and robotics, as well as technology evaluation, for its application as enhancers of medical practice. The academic program has been nurtured by international models such as UNESCO ICT Competency Standards, European Digital Competency Framework for Citizens, Core Entrustable Professional Activities for Entering Residency of the Association of American Medical Colleges (AAMC), and Milestone Clinical Informatics Project of the Accreditation Council for Graduate Medical Education (AMGME). In almost 10 years, more than 100 teachers and teaching assistants have been trained to teach more than 15,000 students through a blended-learning model. The vision of the DIB is to be a national and Latin America benchmark model for training health professionals to apply the knowledge and tools of digital health to help raise the quality of medical care through the rational use of technological resources.