MiracleFeet will outline key challenges and lessons learned from managing a global deployment of a mobile patient management application used in clubfoot treatment. The application, called CAST, is currently used by 245 users across 25 countries. The app has been well-received by end users and has improved the quality and visibility of data collected in clubfoot clinics. However, MiracleFeet and its implementing partners have encountered technical and institutional challenges in rolling out and managing CAST, including challenges coordinating the many components of the technology stack, ensuring that app administrators and end users have adequate training, addressing how this technology affects the roles of clinic staff, managing the needs of different countries, languages, and cultures, and ensuring that end users have access to the data they are collecting. We will share how we have approached these challenges and what we have learned in the process.

Since 2003, Tula has worked in partnership with the Ministry of Health in Guatemala to implement a digital health network, which aims to improve the health of vulnerable populations by strengthening the delivery of primary health services in commonly under-served communities. Tula’s digital health network uses smartphone-based technologies to connect more than 4,000 trained front-line health personnel, providing access to telephone, SMS, and Internet-based communication, such as WhatsApp, and a CommCare-based health data application. In 2016, following a period of demonstrated success and sustained partnership with the Ministry of Health, Tula initiated a transition to scale of its digital health network alongside a unique public-private partnership with the Ministry of Health in Guatemala, Tigo Foundation, and Global Affairs Canada. Since initiating its transition to scale, Tula’s digital health initiative has enabled more than 600,000 telephone calls (~10,000/weekly) connecting front-line health personnel, and registered more than 30,000 pregnancy cases and 131,000 malnourished children as part its real-time community-based surveillance system. In this presentation, Tula will discuss its scaling-up approach, based on the International Development Innovation Alliance’s (IDIA) Scaling Pathway, and its lessons learned while implementing a digital health initiative in Guatemala. In Tula's experience, the transition to scale is less a challenge of technical capacity, and more a challenge of designing and implementing a digital health initiative that remains responsive to the actual needs of front-line health personnel. To address this challenge, Tula analyzes the scalability and sustainability of its digital health network by examining influencing factors in the implementation ecosystem; both internal and external or environmental. In doing so, Tula has remained organizationally flexible, while continuing to be responsive to changes in the implementation ecosystem.

Data driven decisions to improve the quality of Maternal and Newborn Health (MNH) care at public health facilities in India has been challenging due to inadequate recording, multiple paper based registers, errors in data recording and reporting, lack of key indicators in service statistics, manual collation and delay in availability of data. Digitization of labour room client case records would help healthcare providers in readily collating and analyzing data and aid them in effective monitoring of key indicators of MNH care. This effective monitoring would ensure optimum recording of data and motivate health workers to adhere to essential clinical practices. Hence, as per a suggestion from the Government of India to test a digital solution, the Maternity Wing Management Information System (MWMIS) was developed and rolled out in the state of Rajasthan with technical assistance from Jhpiego. Post-facto digitization of 40 essential data elements from each client case record by data entry operators posted at the facilities was proposed, keeping feasibility in mind. The system has inbuilt data analytics and dashboards which are readily accessible by district, state and national level program managers and utilized for effective program review and decision-making in order to improve the quality of care around childbirth provided by the facilities. Till date, 63,486 labour room case sheets have been entered in MWMIS. Completeness of critical indicators rose from 48% in November 2018 to 77% in March 2019. Adherence to key clinical practices also improved during the same period such as assessment of mother’s BP (25% to 87%) and temperature (86% to 94%) at discharge, assessment of mother’s temperature and BP at admission (82% to 95% each) and fetal heart sound (89% to 96%).