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					Leveraging 4,000,000,000 Phones
for Development:
TRACnet: A Case Study from Rwanda


by
Pamela Johnson, Voxiva
Ruton Hinda, TRACplus
Jean Philbert Nsengimana, Voxiva SARL




Mobile Innovations for Social and Economic Transformation:
From Pilots to Scaled-up Implementation

September 16, 2009
Outline
Leveraging 4,000,000,000 Phones for Development:
TRACnet, A Case Study from Rwanda

I.        Background

II.       TRACnet

III. Implementing at Scale
      –        ICT Infrastructure
      –        Architecture and Integration
      –        Sustaining Large-Scale Systems

IV.       Extending the Model
      –        Rwanda
           •      eSoko
           •      mUbuzima
      –        Other Countries

V.        Conclusions



                                                   2
I. BACKGROUND: Rwanda*
                 •   Nine million people

                 •   GDP/capita – $ 314/ year

                 •   Health Statistics
                      –   Life expectancy
                           •   44, males
                           •   47, females
                      –   Immunization rate: 90%
                      –   Infant mortality rate: 86
                      –   Maternal mortality rate: 750/100,000
                          live births

                 •   517 Health Centers

                 •   Health Professionals
                      –   401 physicians
                      –   3593 nurses
                      –   30,000 + Community Health Workers




                 *www.statistics.rw.gov, UNICEF, MoH
   II. TRACnet:
                                                        A GoR information system that
                                                          supports the national HIV/AIDS
                                                          and other health programs.
                                                        Builds on existing
                                                          telecommunications
                                                          infrastructure
                         SAMPLE DATA




                                                        Allows TRACplus to:
                                                        • Collect real-time information
                                                          from the field via web, phone,
                                                          mobile application, paper...
                                                        • Communicate and send alerts
                                                          and information back out to the
                                                          field in a timely and systematic
                                                          way.
                                                        • View Rapid visualization of data
PCs/       Cell    PDA/
                   Smartphone          Phone
                                               Local      – in charts, tables, graphs and
Internet   Phone
                                               Applications
                                                          dashboards
COVERAGE
• 2004: TRACnet launched to support
  national ART treatment program
  operating in 16 facilities
• 2009: operating in all 225 ART
  treatment facilities in all districts
• End of 2009: expansion planned to
  all health facilities nationwide

5 CORE MODULES
• Patient Registry
    •   Patient Registry
    •   Longitudinal Patient Record
•   Program Indicators
    •   ART, VCT, PMTCT
    •   Key Performance Indicators
    •   Analytics and management views
•   Inventory
    •   Stock-level reporting
    •   Stock-out and shortage alerts
•   Laboratories
    •   Lab result reporting and access from the
        field.
   Disease Surveillance and Outbreak
    Alert
As soon as data is in the system,                           National
supervisors at multiple-levels view   SAMPLE DATA
and analyze data in real-time via
a web-based dashboard. They                                      Disttrict
can:
• Track new reports
• Map and analyze data
• Track and manage people.
                                                                       Facility
They can use communication
tools to send alerts and broadcast
messages out to the field.


                                                    Sample dashboards.
TRACnet: Results to Date
ACCESS AND USE
• Widespread access - over 1,000 users at 219 facilities throughout Rwanda
• > 7500 user sessions in April 2009 = > 85,000 sessions/year
• Multi-channel access - using a national toll-free phone number, the web, a PC client
   software, and a mobile phone client
• 90% facilities reporting by IVR
• Access to robust and easily navigable dataset of HIV/AIDS program indicators and
   patient data

DATA
• Aggregate program indicators since 2004 from all ART facilities and patient data
• > 95% routine reporting
• Longitudinal data on over 105,000 patients in care and treatment

TECHNOLOGY
• A scaled national infrastructure - secure, access controlled, redundant infrastructure,
   hosted in Rwanda at a carrier grade data center and managed 24x7
• > 99% uptime
• A robust enterprise architecture – built to support an evolutionary infrastructure,
   TRACnet leverages a standards based infrastructure and software platform, evolving into
   an open standards framework for scale and interoperability
III: Implementing at Scale

• ICT Infrastructure

• Architecture and Integration

• Sustaining Large-scale Systems




                                   9
a. ICT Infrastructure
1998             2008
                 Coverage Super-imposed on Health Facilities
Current Reality:
•Mobile is here
•Internet is coming
•You don’t have to wait


                          Future Directions
                             – Three mobile carriers
                             – Fiber optic to be completed
                               by 2009 (government, MTN
                               initiatives)
                             – Submarine cable connection
                             – Kigali, all district hospitals
                               connected
                             – Site-level investments in
                               infrastructure and data
                               management
                             – Support for connectivity in
                               schools and health facilities
b. Sustaining Large-Scale Systems
    SIMPLE                   BACK-END: NOT
    FOR THE                  QUITE SO SIMPLE
    END
    USER
c: Architecture: Status Quo
                                     MOH
                                                          Disease
                   TB     Malaria HIV/AIDS MCH    EPI
                                                           Surv.



 Donor 1                                                               Provincial
                                                                     Health Authority
                3k9dbns                          si986hs
Donor 2             X5t6hs                              X5t77s
                                                                         District
                                                                     Health Authority
                 3k9dbns                          X5t6hs
                   0kb3YY                           3k9dbns
Donor 3                                                                   Labs
                N7uKK0                            0kb3YY
                   X5t6hs9w                         X5t6hs9w           Warehouse/
 Etc                                                                Distribution Center




                 NGO        NGO      NGO         NGO        NGO


 In Peru, health workers spend 40% of time on paperwork and admin tasks.
Architecture: Integrated system

                       • Rwanda eHealth
                         Strategy
                       • Integrated national
                         system of systems
                       • Common standards,
                         e.g. facility ID, national
                         ID, SNOMED, etc
IV. Extending the Model: eSoko




                                 15
Extending the Model: mUbuzima
Community Health Workers
Other Countries

• India
   – Monitoring supply chain of family planning and other commodities to
     the community level
• Peru, Tanzania and Panama
   – National disease surveillance
• Peru
   – Monitoring maternal health program
   – Citizen safety
• Nigeria
   – Monitoring and evaluation of national HIV/AIDS program
• Zambia
   – Support for patients post-circumcision
• Kenya
   – Compliance support for patients on ART
   – Distribution of agricultural commodities
• Mexico
   – Compliance support for patients on ART
   – Cardiovascular risk assessment and support for behavior change
   – Support for diabetes patients

                                                                           17
V. Conclusions

• Mobile is here. Internet is coming

• Mobile telecommunication systems can be
  leveraged into large-scale enterprise information
  systems

• Mobile can be used to support health and other
  development sectors

• Sustaining any large scale enterprise information
  system requires investments in human capacity to
  use and maintain the system

• Mobile is a tool to reach citizens with services


                                                      18

				
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