For more than a century Afghanistan has been unstable, facing decades of war, social problems, and intense poverty. As a result, large part of the population suffers from a variety of mental health problems. The Government recognises the situation and has prioritised mental health, but progress is slow and services outside of Kabul remain poor. Methods: An international collaborative implemented a project in Badakshan province of Afghanistan using conventional and simple low-cost e-Health solutions to address the four most common issues: Depression, psychosis, Post Traumatic Stress Disorder (PTSD), and substance abuse. Conventional townhall meetings informed community members to raise awareness and knowledge. In addition, an android-based mobile application used WHO’s mhGAP guidelines and protocols to: collect information from community healthcare workers; provide referral services to patients; provide blended learning to improve providers` mental health knowledge, skills, and practice; and to provide store-and forward and live consultations. Results: Preliminary evaluation shows enhanced access to care for remote communities, decreased stigma, and improved quality of health services. Primary workers are also able to bridge the gap in consultations for rural and remote communities connecting them with specialists and providing better access to care. Mobile based learning for health providers showed significant change in the case districts, where overall knowledge scores changed from 45% in pre-intervention test to 63% in post-intervention test. Overall background knowledge of pre to post module test scores changed from 30% to 40%, knowledge of symptoms showed correct responses raised from 25% to 44%, knowledge related to causes of depression from overall districts showed change from 22% to 51%, and treatment knowledge of depression improved from 29% to 35%. Conclusion: The study confirms that a mobile application for health providers in Badakshan, Afghanistan, helped enhance their knowledge and competency for providing better care.

This session describes the user-centered design process and development decisions for a mobile application for tuberculosis screening, tracking, referral, and reporting among private clinical facilities in Nigeria. Paper-based TB screening, referral and reporting in private clinics, laboratories, pharmacies, and patent and proprietary medicine vendors (PPMVs) results in poor record-keeping, delayed decision-making, and patient loss to follow-up. A mobile-enabled digital application can address these challenges if designed in partnership with clinical stakeholders. The Sustaining Health Outcomes through the Private Sector (SHOPS) Plus project convened a user-centered design workshop to develop user interface, experience, and functionality of an Android-based mobile app for a variety of “networked” private provider types (clinics, hospitals, labs, and PPMVs that are part of the SHOPS Plus “hub-and spoke” private provider networks in Lagos and Kano states). Two two-day workshops were held in Lagos and Kano, which convened stakeholders from private clinics, hospitals, laboratories, pharmacies, and PPMVs. After an initial plenary orientation, stakeholders broke into groups to engage in iterative diagramming of patient pathways and prioritized app functionalities. Several desired functionalities emerged across stakeholder types: screening, reporting, referral of patients, automated SMS-based communication with patients, and a personalized dashboard, with each functionality having distinct specifications by stakeholder type. For screening, clinic/hospital/laboratory users wanted seven standard questions with radio dial buttons while PPMVs/pharmacists wanted a simplified tool with one question. PPMV/pharmacist/laboratory prioritized in-app notifications of clinic referrals and SMS notifications to patients for testing/referral. PPMV/pharmacist/clinic/hospital prioritized digitizing forms to improve tracking of sputum samples sent to laboratories. All stakeholders wanted access to patient records and summary statistics for patients screened, presumptive, confirmed, referred, and treated. Bold colors, large buttons, and simple icons were desired for UX. English and Hausa languages, Android OS, and offline capability were prioritized.

This session presents experiences from the development and implementation of free, on-demand, interactive voice response (IVR) audio job aids (AJAs) on family planning counseling and service delivery that were created to complement in-person training received by providers in Nigeria. Global evidence indicates that standalone mobile AJAs on clinical service provision are not effective, but that in-person clinical training is more effective when there is ongoing engagement and training follow-up. There will be three parts to this presentation: 1. The first part will provide an overview of the activity, implemented by the Sustaining Health Outcomes through the Private Sector (SHOPS) Plus project. This includes both on-demand and scheduled push IVR messages and quizzes. This section will highlight design choices for the AJAs including clinical provider preferences for content, voice, and timing of on-demand and complementary push messages. This data was gleaned from participatory stakeholder workshops and ad-hoc qualitative feedback during implementation. 2. The second part will describe the unique 3-2-1 partnership that supports free access to the on-demand content. An existing partnership between Airtel, a local mobile network operator (MNO), and Viamo, an aggregator and content curator, made health and other development sector content available for free to Airtel subscribers in Nigeria. SHOPS Plus leveraged this platform and added related technical content for providers, but using this platform entailed key trade-offs for the program, which will be discussed. 3. Finally, SHOPS Plus will present on initial lessons learned from routine monitoring and evaluation data during the implementation of the AJAs in two states in Nigeria. Launched in July, the program will have five months of usage statistics, quiz responses, and feedback from providers to share with session participants.