“Improving healthcare and saving lives using mobile technology”

 “naloha”: 

demystifying the mHealth project in Kilfi.

Sponsored by Rotary Club of Kilifi and Rotary Club of Vinnings (Atlanta, USA) through the KilifiKids Initiative.

Implemented by Medic Mobile – Rural Health Care Systems specialists.

Improving healthcare and saving lives

using mobile technology”

                                            A Community Health Worker gets baby temperature and submits records via SMS                                              ( Photo courtesy of Mali Health Organizing Project)

 “There can be no real growth without healthy populations. 
No sustainable development without tackling disease and malnutrition. 
 No international security without assisting crisis-ridden countries. And no hope for the spread of freedom, democracy and human dignity unless we treat health as a basic human right.”
 Gro Brundtland, Director-General, World HealthOrganization1998-2003

Naloha – a MijiKenda word meaning “I dream” - is a noble project that brings in partnership between the Ministry of Health (through the Kilifi District Hospital) and the Rotary Club of Kilifi. It was conceived on the basis that Healthcare is the primary concern of any healthy society.

Its formation follows reports in scientific journals on the high rate of malnutrition in Kilifi district in children under 5 years of age, as well as the high rate of infection with communicable diseases among children and pregnant mothers. Adherence to drug administration, turn up for appointments, referrals and high rates of default for key immunizations and checkups amongst patients have been a main driving force towards the establishment of this project. Mobile technology growth for personal use has been on the rise in Africa, and Kenya area has embraced the same within remarkable rates. The project therefore seeks to make use of the mobile network coverage and use for successful implementation.

With funding from Rotary International and the generous support of KilifiKids (a US based NGO), have managed to successfully implement Phase I of the project in 2009-2011, whose main target was improved reporting by Health facilities of Kilifi District. Naloha is the Phase II implementation of the project and seeks to leverage the use of mobile technology towards sustainable rural health care.

The Phase II of the project will be implemented with technical assistance from Medic Mobile, a US based NGO that has a worldwide presence supporting use of Mobile phone based computer systems in rural Healthcare. Medic Mobile will work closely with the Ministry of Health, through KDH, in Kilifi and Ganze to see a smooth take off.

Why mHealth ?

    I.      What is mHealth? – a short form of mobile Health. Mobile phone, a portable communication device; Health – a basic human right for survival. mHealth conotates to the use of mobile phone technology to ease access of healthcare. It is a development of electronic Health Information System (eHIS) commonly used in developed countries and made possible by use of electronic media capitalizing on use of computer systems.

   II.      What is the project objective? The core objective of this project is to leverage the use of mobile technology to improve on healthcare uptake in rural Kilifi. Reducing the rates of malnutrition being the original objective, the IMCI approach becomes the main block and offers a strategic direction to the mHealth project.

  III. What does mHealth involve? In mHealth mobile phones and texting are the main features, health information is communicated to and fro via text messages popularly known as SMS - Short Messaging Service. A computer system that allows for easy access of the texts is involved and is located centrally to manage the entire mHealth initiative.

 IV.      How is mHealth different from other electronic health systems? – Other electronic systems involve managing patient information but lack an interface to communicate with the patient. mHealth SMS system allows health facility staff to store patient records and information as well as to communicate to the patients via the sms facility that is available in all mobile phones. Though it is not easy to frame text messages, this project will make use of SMS templates for standard texting and unstructured SMSs for general texting. The participants will therefore be trained on how to access the template SMSs and how to fill them in. The training shall ensure that all the messaging settings are set correctly to allow the user to know when text has been delivered to the intended receiver. Participants will be taken through the entire setup to ensure that the correct message Centre and values are selected.

       Why use mobile phones?

Mobile phone coverage in Kenya stands at 62% of the population with over 80% network coverage round the country. Mobile use literacy is however far high than the coverage and usage statistics with an estimated 80%+ of the population being able to use the device. Texting is quite popular within the Kenyan cellular context with custom texts like “Please call me” for callers without airtime in their phones being quite popular. Messaging therefore is a familiar tool to most of the users.

  Why Kilifi-Ganze, Kenya?

 Kenya is one of the highly developing countries in Africa. Access to proper healthcare in the rural areas remains a great challenge. Kilifi has been ranked as one of the poorest districts in Kenya, leading to high cases of infectious diseases, malnutrition and other childhood diseases. Ganze is one of the areas identified by the project as a beneficiary owing to the fact that it has one of the most active community units managed by a team of approximately forty Community Health Workers (CHWs).

The implementing partners undertook a pilot phase in Ganze with the Pentanguo CHWs. The Unit is served by the Ganze Health Facility that has a Clinical Officer and Community Health Extension Workers (CHEWS). The harmonious working relationship between the parties involved makes the choice of Ganze quite strategic for the pilot.

Once project is deemed successful in the pilot, it will be scaled up to other health units within the district and hopefully to the entire county with regular recommendations made to the Ministry of Health at a national levels.

Why work with CHWs?

Community Health Workers (CHW) are the primary healthcare givers in rural Kenya. These are community volunteers who are available to support their communities in any health related issues.

The CHW network has been strong in Kilifi district with a relatively good social motivation that has seen the turnover levels remain to the bare minimum. A mixture of men and women CHWs makes it so unique and demonstrates the appreciation of healthcare by the community.

Each CHW manages an average of 20 households with an average of 5 to 10 house members. More focus is given to children under five years and pregnant mothers, who lie within a high risk zone.

This project thus comes in to complement the existing efforts CHWs are committing to their own community.

The project will initially work with a group of 40 CHWs then expand as required.
 
Roles of the different partners

Naloha will be implemented by five main partners ;

1.  Rotary Club of Kilifi / Rotary International
2.  Kilifi Kids
3.  Medics Mobile
4.  Ministry of Health
5.  CHWs

Rotary International

Disease prevention and treatment is one of Rotary's areas of focus. RI is the core financier of the project through the Rotary Club of Kilifi and Rotary Club of Vinnings, who are the primary partners, will implement and steer the project to succession.

Kilifi Kids

A USA based NGO that receives funding from Rotary International and is responsible for research and development of the project. They are the main interface between Rotary Club of Kilifi and Rotary International.

Medic Mobile

These are the technical back stoppers and key implementers of the project. With mobile phone systems, technical experience and resource base, Medic Mobile runs the show of ensuring training, procurement and actual implementation of the project.

They provide progress reports to Kilifi Kids and have a local representative to work on the day to day activities.

Ministry of Health

The Government of Kenya through the Ministry of Health and Kilifi District Hospital are the main duty bearers of the healthcare system in Kilifi district. Through the department of Health records the Ministry provides the technical support and offers good will and liaison with the community based system. Their key role is to ensure that the successes of the project are shared across board and provide a harmonious working relationship between the primary implementers and the healthcare channels.

Community Health Workers –CHWs

These are the working group that will determine the success of the project as they are the ones to run the actual interventions. They will be required to ensure that the working equipment is maintained in good working condition and any loses/ malfunctions reported ASAP.

For the success of the project, text messages are very key and thus the CHWs will be held responsible to sending different texts for the different interventions.

Project Use cases

This project revolves around four use cases that relate to the project area;

1.  Registration of newborns and pregnant mothers

2.  Referrals

3.  Appointment scheduling and monitoring

4.  Defaulter tracing

Registration of newborns and pregnant mothers

A generic SMS will be generated and send to the SMS system that will contain the name of the child /mother , date of birth / conception. With this information the system will automatically schedule the above for different appointments

Referrals

Once a CHW meets a patient in the field, they normally are given a referral sheet that will facilitate visit to the health facility. Once this has been done, the CHW will sent a referral SMS/ Text such that by the time the patient gets to the facility they will already be in the queue. Good enough for emergencies where immediate support can be offered.

Appointment Scheduling and monitoring

Once different appointments have been scheduled during registration, reminder texts will be sent to CHWs and sometimes to patients to remind them of their appointment. This will be sent 2 days before the appointment.

Defaulter tracing

A defaulter here in refers to any patient who does not appear for their scheduled visit. Within 5 days of defaulting the system will be set to generate a text specific on the patient and appointment name they have defaulted. This shall be sent to the CHW and possibly the patient. With this the facility would be able to catch up with defaulters within the week.
 
FrontlineSMS and Patient View

FrontlineSMS is a bulk SMS platform that allows for use of a GSM modem/gateway to link up with a computer system to send and receive texts. Patient view on other hand is a plugin software that works hand in hand with frontlinesms to store patient records and at the same time communicate to CHWs and patients via texting. The software shall be used and training shall be offered to facility staff.

Rotary Club of Kilifi and Vutakaka Junior School Well Project

Rotary Club of Kilifi and Vutakaka Junior School Well Project

Well under construction at VJS, September 2011

Vutakaka Junior School (VJS) is a community school based in Takaungu, a poor rural area on the coast of Kenya. Founded in 2003, VJS visionaries wanted to provide the local community with an opportunity to attend a school targeting to provide high education standards albeit at a low cost. The major source of funds for the school is the East African Center for the Empowerment of Women and Children (EAC), charitable organizations and other well-wishers, mainly in the USA.(http://www.eastafricancenter.org/baraza)

With the failing rains and poor harvests from the small scale farmers over the last three years, public schools have had to grapple with increased admissions due to the free food programme offered by the government. As such, the EAC was at a dilemma… to increase the cost of education for the over 200 students to purchase food supplies, or to search for a more sustainable method of providing free food (lunch) to the deserving students. While very important, this free lunch program would be very costly to maintain.  An idea was born to develop the extra 3 acres on the school property into a farm that could be run by students and school staff to meet many of the school’s food needs. This would eventually ensure a sustainable supply of nutritious food for generations of students at VJS. Initial funding for the well was raised by the American International Women’s Group of Genoa, which allowed for the hydro-geological survey and the digging of the well.

Having participated in a massive food drive 2009 that saw over 3000 families provided with relief food, this seemed quite the ideal project for the Rotary club of Kilifi to step into. Thus, the club recently awarded two 100,000 KSH grants towards food security in Kilifi District after competitive bidding from several organizations. One proud recipient of the grant was Vutakaka Junior School. The school was awarded the money to complete the construction of a well for their farm project, which would in turn grow the food needed for the student’s lunch each day.

The Rotary Club of Kilifi felt that this project was in line with the stated goals of increasing food security for the community, serving a disadvantaged population in Kilifi District, and most important sustainable after initial funding. The money was awarded to buy the pump for the well and for a 1000-litre tank to store water for irrigation. As their contribution, The EAC agreed to raise funds for the stand to put the tank on and to connect the electricity to the pump.

The project is in its final stages of completion.

 

 

The pump has already been installed and connected to the electricity supply. The tank has been purchased while the stand for the tank is almost complete. Once this is finished, the tank will go up and the staff and students can begin pumping water to be used for irrigating vegetables year-round. As the wise old Swahili leaders would say, “Kidole kimoja hakivunji chawa” (One finger cannot kill a louse.)

The School Deworming Project, 2006 - 2014

 

The school deworming project has been one of the most successful and far-reaching projects that has been conducted by RC Kilifi with support from RC Ashylum. Implemented in conjunction with the Ministry of Health and Public Sanitation and the Ministry of Education in Kilifi, the project targets the provision of deworming tablets to primary school going children in Ganze and Vitengeni. The first phase of the project kicked off in June 2006, has been running ever since, and is expected to last till 2014 after receiving an extension of the initial grant. 

In the last 5 years, the four partners have successfully conducted 6 rounds of deworming in all primary school going children in Vitengeni and Ganze. An impact assessment study was carried out in Nivember 2010 and the following achievements were noted:

-         the prevalence of S. haematobium, dropped from 37.9% to less than 1%. This parasite causes bilharzia, a chronic illness that can damage internal organs, and in children specifically, impair growth and cognitive development.

-         3.6% of the children have either E. coli and T. trichiura, down from 40%. These microbes are occasionally responsible for food poisoning

-         There was an improvement in the knowledge of personal hygiene across all ages of the children

The teachers, who undergo a brief training on drug distribution, were found to be quite effective and had minimal supervision from health workers. To cap all these achievements, the Club got a grant period extension from Rotary International and additional funds to incorporate school sanitation projects which will involve construction of toilet blocks in select schools. Two schools have already been identified in the pilot project, and the toilet blocks will follow a similar model to those constructed through the Club at Ngamani Primary School. The partners also expect to conduct another round of deworming in October 2011, targeting the schools in Ganze and Vitengeni. 

Despite these humble efforts, with financial support from the Rotary Club of Ashylum and Rotary International, there is an uncertainty of the continuity of the project beyond Rotary Sponsorship, especially to other deserving areas in the district and beyond. However, step by step, and the dedication of the Rotarians in the spirit of “Service above Self” will assist to realise their goal of a worm free environment for school children.

RC Kilifi Project Reports 2012

In the next few weeks, Rotary Club of Kilifi will be posting its reports for all its members and well wishers to see here on our blog! Make sure you follow us to hear about the following projects: 

• mHealth, where we are empowering community health workers to harness mobile phone technology so that they can provide timely and accurate records to the Ministry of Public Health & Sanitation at kilifi District Hospital.
• Vutakaka Jr School shamba project, aiming at providing a sustainable way of providing fresh farm produce to students and community in Takaungu.
• Kilifi Kids project, which provides an opportunity to the bright but poor children in Kilifi district to access secondary school through a full scholarship scheme.
• School deworming project, which aims at distributing deworming tablets to students in primary schools in Kilifi District.

For these projects and others, a total of over $240,000 has been spent since June 2006. Find out more on how the dedicated team of 12 active Rotarians have been doing this.

Service above self!

Partnering for Education: RC Kilifi, KESHO and KilifiKids

The second set of a series of videos shot by Erik Michielsen during the epic tour by KilifiKids Organization committee is finally out. In this video, we hear about how the partnership between these three like-minded organizations  have helped improve the lives of over 300 students to date through primary and secondary school sponsorships. 

Follow this link to the awesome video, where we get to hear first hand accounts of the details from a few of the students: RC Kilifi, KESHO & KilifiKids partnership

Background

RC Kilifi is a keen partner in the sponsorship of selected bright students from disadvantaged backgrounds within the community living in Kilifi County. The club partners with robust Rotarians from RC Amersham (USA), spearheaded by one of KilifiKids founders, Michael Olsen. Out of the 25 students (16 girls, 9 boys)  in secondary schools currently under its wing, two of them are in prestigious national schools (Nairobi School and Limuru Girls), while the rest are in provincial schools located in Kilifi county. 

With an initial target of 50 students, the program is now in its third year of running. However, the clubs are facing the challenge of drying up of funds, as fees for the various schools keep on escalating each year. The average cost of sponsoring a secondary school student at national level is almost twice that of sponsoring one at the provincial level. Due to this, no extra student was selected for sponsorship this current year, with the funds available just enough to sponsor the students currently in the program. Despite this, the partnership has achieved commendable results as can be heard in the video interviews.

Is school-based education all they get?

The students need more than just their school fees to be paid in order for them to have the opportunity to rise up to their potential and sustain the momentum. As part of Kesho's Youth Development Programme, the students are exposed to academic guidance and counselling during the holidays by Rotarians from Kilifi, Moving The Goalposts (MTG) and other partners. Some students are also involved in Kesho/Rotary/MTG peer support groups in their schools.  In addition, several open days have been held during the year 2010, including a Careers Day, a Reproductive Health Day, and a Parents Day to expose the students to pertinent issued that are of great concern to their academic development. This year RC Kilifi  hosted an open day targeting the Rotary sponsored students, to orientate them about the work of Rotary in the community and the world. The event was well attended with the Rotarians allowing the students to talk freely, get to know each other,and giving motivation speeches and the raison d'etre of Rotary Clubs worldwide.

My name is..

Open session, where motivation talks,
problems encountered in school, and what Rotary
is all about were discussed.

"A student does not live on books alone",
so to speak.

Ruth, an active Rotarian-to-be, shows us how to jig
in the warm up session.

One on one interaction with the students

Rtn Zena gives a wrap up of the day

Envisioned future plans

RC Kilifi and KilifiKids are working in earnest to see that the initial target of sponsoring 50 students is met, and that all the students perform well in their exams, despite the setbacks. The first cohort of Rotary sponsored students will graduate from their respective secondary school at the end of 2011 (12 in total). Students who gain a C+ or above in their KCSE examination are selected through the Joint Admission Board for subsidized degree-level education in the public universities. However, competition is quite tough for the spaces available in the universities for the degree of choice, thus a candidate has to perform exceptionally well. All  not lost, however, as a range of other tertiary institutions exist for diploma and certificate-level training. 

With the community's and other well-wishers support, our students will be assured of access to quality education, and an opportunity to make lemonade from the lemons we have. We also hope to mine and mould quality leaders at this young age through mentorship in the ideals of Rotary.

One big happy family of students and Rotarians.

Kilifi Kids and RC Kilifi mHealth Collaborative Project

Exciting news here.  The first of a series of videos from the Kilifi Kids (www.kilifikids.org) trip to Kenya this July has been published. The video highlights Kilifi Kids efforts on working with the team and community across Kilifi to develop the mobile health care or mHealth project.

Each one of the team members played a key role in the effort, ranging from trip preparation, to Nairobi visits, to Kilifi interviews and meetings.  On behalf of Team Kilifi Kids, Eric thanks us all.

Please pass this link along using email, LinkedIn, Facebook, Twitter, etc. as Kilifi Kids and RC Kilifi want to build awareness of the project and position for next step institutional financing, team development, and media / publicity exposure, including journalist interviews, guest blog posts, conference presentations / panel participation, etc.

Here is the link to the video:  http://www.vimeo.com/14417388

Note that you have ability to download it on the Vimeo site if that is preferred. Additional videos are forthcoming.  These will be rolled out in the coming months. They will be available on Vimeo as well as on www.kilifikids.org and their social media channels.  If you have not yet done so already, please follow Kilifi Kids on Twitter (www.twitter.com/kilifikids) and on Facebook (www.facebook.com/kilifikids).

Service above self.

What is a responsible Rotarian?

Who really said "You are what you eat?". Let us stop to think about it... is it really the case? On the other hand, sociologists also say that "You are judged by the friends you keep". And still, "If it walks like a duck and quacks like a duck... then, definitely it is a duck". Honestly, we all wonder why these statements were made, if not to prove a certain spur-of-the-moment point. Alas, they are common phrases which we quote from time to time.

What are my responsibilities as a Rotarian? From a point blank perspective, the responsibilities can be broadly categorized as: attendance, service, finding and keeping members, payment of dues and leadership.

RC Kilifi members during a weekly meeting.

As a Rotarian, my biggest responsibility is attending the scheduled weekly club meetings and actively participating in its activities. The beauty of attending the meetings is having fellowship with other members, enriching our professional and personal knowledge through the contacts we make, and meeting other business leaders in our community. Even during the formative years, club meetings, assemblies, training seminars and conferences have always been an opportunity to make new acquaintances and spread peace and goodwill throughout the world. In the spirit of brotherhood/sisterhood, guests are encouraged to visit other Rotary Clubs to get a chance to make up for lost meetings in their parent club, and also to see how things are done in host clubs. Ideas are never copied; they are just adopted and adapted to suit local conditions.

Food chain during the successful food drive for Kilifi
District residents in early 2009.

Serving the community through Rotary stems out from the motto: Service above self. Rotary gives all members a chance to participate in local and international service projects by volunteering their time and talents whenever possible. Through its flexible structure, members serve the community (and club) through the five avenues of service: Club Service, Vocational Service, Community Service, International Service, and New Generations Service. All these five pillars are run by dedicated members who always rise up to the occasion at hand and deliver without fail. Decisions are made after lengthy discussions based on strategic goals, and duties performed to high ethical standards in order to improve the quality of life in the local and global community. The youth and young adults are greatly encouraged to join in and participate in Rotary activities due to the foreseen positive changes that will be instilled in them through leadership development activities, service projects, and exchange programs.

Rotarian Kate (current Club Treasurer) during her induction.

"Reach one, Keep one" is a simple but powerful phrase. Every Rotarian is encouraged to bring new and like-minded people into the club for meetings, or to participate in a service project.  The best way to motivate a potential member to join Rotary after the initial invitation is to encourage them to utilize their talents and expertise in service beyond their normal professional activities. But then, how do we keep membership attrition rates low?  Sustaining membership is a challenge in this dynamic world that all clubs face, but solutions can be generated to suit particular situations.

Annual dues are an obligation to each registered member. The dues go to sustain the Rotary clubs, districts and Rotary International, as well as the subscription fee to the appropriate Rotary magazine. A simple solution to mitigate the seemingly high dues would be to stagger the payment over the Rotary year period. Regular reminders to contributing members also serve as an impetus for them to contribute to the worthy cause of humanitarian aid. Apart from these dues, other contribution schemes exist, including the Every Rotarian Every Year (EREY), Friends of Rotary, and the Paul Harris Fellowship (PHF). While these other schemes are not obligatory, members are highly encouraged to contribute towards sustaining The Rotary Foundation.

Some people are born leaders, some leaders are created through cultivation. There is virtually a position for every Rotarian in the club, and members are always encouraged to volunteer for leadership roles at club level and beyond. No leader works in isolation, and all members are available to support the leader of the team as the club makes its way through service projects. The greatest joy in the team is when a daunting task is surmounted, and smiles are seen on the faces of the community that has been touched by a Rotary-sponsored project.

Donation of a laptop to Charo, member of the
Kilifi visually impaired group.