Last Mile Initiative

Welcome to IntraHealth Informatics Last Mile Initiative Wiki.

This page will have updates on all of the ongoing work being done for the SRA/IntraHealth Last Mile Initiative Community Health Data Collection System.

What is the Last Mile Initiative

The overall objective of the USAID Last Mile Initiative (LMI) is to expand rural poor communities’ access to telecommunications using sustainable and scalable approaches in order to improve livelihoods and access to development opportunities.

Within the context of LMI, the project objective is to design, develop, install and pilot usage of a telecommunications-enabled Community Health Services Information System for the health sector in Rwanda. Using the paper-based system already developed by the Twubakane Program as the base, IntraHealth will design an Open Source application for data collection and reporting via cell phones and other mobile devices. The data system will improve the capabilities, impact, and timeliness of the current paper-based system by allowing easier data entry of health service indicators and also improving the ability to measure performance of these indicators against district, national, and global targets.

The automated system itself is designed to rely on a centralized voice-response unit. Community health workers will make phone calls to the central processor and will be prompted to provide service data on a set of pre-determined indicators. The data collected via the voice response system will then be written to the database. Managers will be able to call into the system to retrieve performance data indicating how well their communities are meeting targets or performing as compared to the district, regional, and/or national averages. The automated system also will support the broadcasting of updates from district, regional, or national authorities that will keep health workers abreast of recent policy changes and disease outbreaks.

The software package used to support the automated system will accommodate a variety of data entry devices ensuring maximum accessibility from remote areas and will include instructional and supporting documentation, multilingual capabilities, a web interface and a set of standardized reports with options for customizing to local conditions.

Major implementation steps include:

1) Manage project and report milestones; 2) Identify, hire and train local developer and local development support team; 3) Develop functional requirements; 4) Design and develop software application; 5) Develop user and technical documentation; 6) Pilot system and make adjustments; and 7) Develop scalability and sustainability plan.

System implementation will rely on local development resources and partnerships. Local development efforts will include a full time Open Source developer, senior Open Source development consulting, ICT support for hardware implementation, local trainers, and local monitoring and evaluation support from the existing Twubakane staff. US-based IntraHealth staff will provide project management leadership and senior systems and development support. Rwanda-based technical assistance from the Twubakane Project will be critical to development of functional requirements and support from TRACplus and the Rwanda Ministry of Health HMIS unit will ensure maximum system integration.

The implementation plan included below contemplates a one year timeline for system delivery including: local team building, stakeholder development, and creation of system specifications and use cases will span 4 months; pilot software and related material development will span 3 months; software introduction, training, support, and monitoring of two pilot districts will take 3 months; and implementing final improvements will take 2 months. Given the short timeline for delivery, local development staff will be supported by US-based senior advisors as needed. Quarterly travel is planned by project management leadership to ensure all timelines are met and that stakeholders remain actively engaged.

Implementation also will be supported via a partnership with Qualcomm who will provide financial support to cover all hardware and software costs as well as training and documentation.

Partners

• IntraHealth International
• SRA
• Qualcomm

Contact Information

David Mason – Health Informatics Advisor - dmason@intrahealth.org – 919. 313.3555

Vanessa Spann – Informatics Team Lead – vspann@intrahealth.org – 919.313.9132

Laure Almairac and Jana Scislowicz – Program Support – lalmairac@intrahealth.org

Updates

• Weekly Updates
• Monthly Updates

Use Cases

• System Use Cases [PDF Format]

Indicators

Indicators

1. Number of infants less that 12 months of age completely vaccinated in the preceding month

2. Number of children aged 12 to 23 months who received one dose of vitamin A during the last month

3. Number of children aged 12 to 23 months who have received a Mebendazole-based de-parasite treatment during the last month

4. Number of feverish children aged 6-59 months who received one dose of anti-malarial medication at the community level in the last month

5. Number of children aged 2-59 months suspected to have pneumonia and treated at the community level during the last month

6. Number of children aged 0 to 59 months suffering from diarrhea and treated with oral rehydration salts and zinc at the community level in the last month

7. Number of home deliveries during the last month

8. Number of home deliveries where mother and neonate were referred to health center during the last month

9. Number of women accompanied for delivery at a health center during the last month

10. Total number of deceased children under the age of 5 in the last month

11. Number of couples sent to the health center for family planning during the last month

12. Number of cycles of oral contraceptives distributed in the course of the last month

13. Number of condoms distributed in the last month

14. Number of couples sent to health center for PMTCT services in the last month

15. Total number of deaths in the last month