Featured image credit: Andy Miah Creative Commons License

Today we had the opportunity to chat with Steve Ollis of D-tree International, who will be a guest expert for our Mobile Phones for Public Health course. Below, he discusses his experience working in the mHealth field!

Can you tell us about your background and experience in mHealth?

I came into mHealth and global health in a somewhat non-traditional way. I actually started off as an accountant and management consultant with BearingPoint, working with various US government military branches on their accounting systems. I moved into IT consulting with a focus on program management for the next six years, working at progressively smaller companies, bringing web applications to state and federal agencies and addressing issues like help desk, user training and support, and change management needed to introduce and sustain new applications in large organizations.

My career in mHealth and global health started with a few short volunteers stints in Kenya and South Africa followed by a position with the Clinton HIV/AIDS Initiative (now Clinton Health Access Initiative) for two years in Tanzania, working in pediatric HIV, commodities, lab systems and Prevention of Mother to Child (PMTCT) programs.

With this exposure to the global health world and my background in information technology, I was intrigued by the possibility of working in the mHealth space and joined D-tree International in Tanzania six years ago. I have been fortunate to work on cutting edge mobile decision support tools focusing on design, development, deployment and support. I have seen projects grow from 1-2 facility to over a hundred facilities, and 5-10 community health workers to thousands of health workers. Over the years I have also seen a dramatic price drop for Android phones from $650 t0 $80. I have worked in Tanzania, Benin, Malawi, Kenya, Sri Lanka and India as part of small and large teams, and have worked at both the community health worker and Ministry of Health levels.

How is mHealth incorporated to your work currently?

D-tree International is a health NGO that uses mobile technology to improve the care provided by frontline health workers. We are working at the government, donor, implementing partner and ground levels to develop applications and systems that support decision makers at all levels, from the community health worker and nurse level to health systems supervisors. We focus on providing mobile decision support tools to health workers, and creating health systems to provide them adequate support. We use mobile technology to improve health outcomes by developing supervisory applications, dashboards, mobile money integration for transport, vital events tracking, and point of care diagnostics.

Why do you think mHealth is important / what impact can learning about the use of mobile phones for public health have on development projects?

It is amazing to think about how we can do things more effectively and efficiently using mobile devices, including data collection, applications, closed user groups and telemedicine. At a higher level it is useful to think about how these innovations can be introduced, scaled and supported in order to create significant impact and change.

What are your thoughts on the future of mHealth, and where you think this field is heading?

We’ll see continuing availability of smartphones at all levels of society and the prices will come down further. The price of data and sms will also be reduced and connectivity will increase at greater bandwidth. These forces will allow for increasingly complex mHealth systems to be developed where data, images and video may be able to be shared even in the most remote areas. Point of care diagnostics will continue to evolve, where the prices and power requirements for certain tests will drop to a point that they become more feasible to deploy at the community level. Mobile money, vouchers and mobile insurance will also play a role as the health workers and clients become more familiar with their use in their day to day lives. Power and lack of unique identifiers will remain significant challenges, but innovative solutions should be available soon in areas where we work.

We believe mHealth skills have the potential to make a huge impact in your work. Why do you think taking this class is important, and who would you recommend it to (public health professionals, field workers, etc etc).

This course provides a great overview of different types of mobile technologies and mHealth projects in addition to providing a unique opportunity to connect with a community of implementers and experts in the field. It will also provide some guidance around processes and structures required to include a successful mHealth component to a project. I am a firm believer in the potential of mHealth to radically transform the current state of healthcare. Everyone from policy makers to healthcare workers need to think about how we can use these tools to save lives and help people live healthier, happier lives.

Any advice for someone who wants to make a career in mHealth?

There are many opportunities available for people from all backgrounds. There is a need for people not only with health and technology skills, but also with sociology, anthropology, finance and business, project management and analytics skills. I think it’s important to be conversant in the technology, but to keep exploring these other areas which are critical to the work we are all doing to introduce and support game changing innovation in health systems for the good of the communities we serve.

About Steve
Steve is D-tree’s Chief Operating Officer with over 20 years experience in management consulting, information technology and public health. Steve holds a Bachelor’s degree in Finance from The American University and a Master’s in Business Administration in Information Systems and Finance from the University of Maryland. He is also a certified Project Management Professional. Prior to joining D-tree, Steve worked for the Clinton HIV/AIDS Initiative in Tanzania directing programs in Pediatrics, Prevention of Mother to Child Transmission of HIV, and Rural Care and Treatment.

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Mobile Health: How Far We’ve Come

When I first started in the field of technology for development back in around 2010, I was working specifically in global health tech, and there weren’t too many of us around. The idea of using technology in places besides the developed world was just starting to gain traction, and even then, it was limited to mostly technologists and a few health experts. Pilotitis was infecting everyone, and every project I worked on for the first few years was a pilot of some sort, with no solid plan to move beyond that stage. The focus was on finding tools and concepts that showed evidence of working, although that ended up being a more difficult task than everyone expected!

Recognizing this, the mHealth Alliance (formerly part of the United Nations Foundation) created programs to incentivize all the many organizations out there to move past the pilot stage and begin exploring how to scale their projects, and eventually other organizations followed suit. Even then, though, the health field at large was still a bit unsure about how to treat digital interventions, especially in terms of evaluation. Do you measure the success of an SMS stock monitoring tool by just counting how many times it was used, or do you count the many patients who were treated using those very drugs kept in stock? Is there even one right way to measure it?

Additionally, nobody could really agree on what terms like “scale” and “sustainability” meant for mobile health tools. It wasn’t until more recent years that the space has truly started to embrace that the definition of “scale” and “success” varies for each project, and that planning for sustainability is paramount for a mobile health product to truly make an impact.

These days, among many lessons learned, it’s widely recognized that like any technology, mobile health tools are great for targeted usages, but at the end of the day, they are just tools that cannot solve problems on their own. Even the sleekest vaccination reminder system, for instance, must be accompanied by an equally well-run vaccination program for it to really benefit a community.

The mobile health community, additionally, has expanded significantly to include a wide variety of experts and crossover roles, from doctors to designers and software developers to supply chain experts. This has contributed to an increasingly holistic view of mobile health, rather than the siloed space that it once was – which is a good thing! The more perspectives you incorporate into projects, the more likely you are to come up with a truly innovative and engaging product.

Looking Forward in Mobile Health

It’s hard to say what the next big breakthrough in mobile health will be, but we’re already starting to see a rise in the number of projects that incorporate more advanced technologies like sensors and wearables alongside mobile phones. These types of additions have the potential to reduce the amount of time and resources needed to activities that currently serve as barriers to access and utilization of health services. We’re still figuring out how these sorts of tools can be best incorporated into healthcare, even in the western world, but we’re making progress. The UNICEF Innovation team even just began testing the usage of drones to speed up the process of testing infants for HIV, which brings a whole new meaning to the concept of “mobile” health tools!

Personally, I think that the biggest changes coming ahead in the near future will not be so much in the tools themselves, but rather in how we use existing tools. With the rise of patient records and other consolidated data sources around the world, I think we’ll soon be seeing a bit more of personalized medicine in the developing world, which will help bring customized care to places where it otherwise would have been difficult to provide. Similarly, better data analytics will lead to smarter interventions – for instance, we’ll have a much better sense of exactly what types of diagnoses are prevalent in specific areas, and thus be able to better support clinicians with their precise needs. And it may sound crazy, but if you want to really look ahead, I do think we’re much closer than you’d imagine to our futuristic vision of robots supporting clinics in hard-to-reach areas. The technology for that exists; it’ll just be a matter of finding ways to make it affordable, accepted, and safe enough to use! That would open up all kinds of new doors to allowing patients with mobile phones to directly connect to their healthcare.

Regardless of what the future holds, one way that you can be prepared to participate in it is by learning more about the space at large, which is why the TechChange Mobile Phones for Public Health course is such an exciting resource! I look forward to meeting the students taking it and seeing the kind of impact they’re able to create.

About the Author
Priyanka Pathak is a technologist and digital designer whose work focuses on co-designing and co-creating technologies for social impact, especially in global health and STEM education for women. Currently, she is a Senior Designer at the Design Impact Group at Dalberg. Previously, Priyanka worked as an ICT and Innovation Specialist at the World Bank, in addition to having taught courses around design, technology, and social good at Parsons the New School and the Copenhagen Institute of Interaction Design. Priyanka holds a masters degree in informatics from Columbia University and bachelors degrees in information systems and business from the University of Texas at Austin, and is currently based in Washington, DC.

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Let’s pick up where we left off in Part 1 of our survey design for quality data series, which was inspired by Dobility founder and CEO Dr. Christopher Robert’s presentation in the TechChange course “Technology for Data Collection and Survey Design.” Lesson 1 focused on designing your survey with empathy for field staff and respondents. Lesson 2 highlighted SurveyCTO tools for building in relevance and constraints. With Lesson 3, we’ll jump into a number of ways that SurveyCTO enables you to automate monitoring and workflow.

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Lesson 3: Automate Monitoring and Workflow 

The staffing structure for a typical survey might look something like this: a research team designs a survey. Thousands of miles away, a field team conducts the surveys. The collected data then goes back to the research team for analysis.

The research team wants to be able to monitor the field team and audit their work throughout the process. Supervisors on the field team may also want to monitor their enumerators. And, just to get complicated, the research team may also hire a survey firm to conduct the survey themselves or to provide an additional layer of monitoring for the field team.

In the case of traditional paper surveys, quality checks might include:

  • a member of the research team accompanies enumerators in the field
  • a supervisor reviews surveys as they come in
  • an independent team conducts “back-checks” after initial surveys are completed, to corroborate the results

Many of the quality checks available when conducting a paper survey occur AFTER the initial surveying is complete. You may not know you have bad data until it’s too costly – and too late – to do anything about it.

One of the most compelling opportunities afforded by SurveyCTO is the ability to easily program a number of quality checks into your survey that can automatically flag issues as they arise. Not only that, with a little extra work up-front, you can prep your data to make the transition to visualization and analysis even faster.

Example 1: Audio audits and speed limits
Back-checks are time-consuming and expensive, so why not listen in from the office? You can program your SurveyCTO surveys to randomly capture audio throughout an interview.

Or, even better, pair audio audits with “speed limits,” which allow you to indicate the minimum time that a particular question should take to ask and answer properly. For example, you can program your survey to automatically start recording after the enumerator violates three speed limits – meaning they didn’t take enough time on three different questions within the same survey.

Since audio audits and speed limits are programmed by the research team, the field team won’t know the specifics – they’ll just know that there’s an additional layer of accountability.

Sample speed limit:
speed_limits

 

Example 2: Automated checks
Our most sophisticated users write quality checks in Stata code, to automatically flag data that doesn’t behave as expected. But we wanted to ensure this best practice is available to all of our users, which is why we’ve built the feature into SurveyCTO.

Spend a few minutes during the survey design phase to set up at least one automated check and you’ll not only be able to identify and address issues right when they arise, you’ll have more reliable data to work with once your surveying is complete.

Sample automated check:
automated_check

 

Example 3: Concatenate and calculate
Let’s say your survey splits first name and last time into two fields but you would prefer it displays in one field during the analysis stage. You can easily program the form builder to concatenate – or link fields together – so that when you output the data, it’s already formatted the way you want it. You can also set up automated calculations, which can help with analysis or serve as a useful relevance trigger during the survey itself.

Sample calculation:
calculation

 

Example 4: Visualize and analyze
As soon as your data is uploaded, you can take advantage of our integrations with Statwing, Google Sheets, Google Earth, Stata, Excel, and Salesforce (via OpenFn.org), or export it to JSON or CSV file formats and start analyzing it in the platform of your choice.

Using a mobile data collection platform enables you to skip the laborious and error-ridden step of data-entry. Instead of spending months entering, checking, and rechecking the data you collected – not to mention storing hundreds (or thousands!) of survey booklets – start analyzing your data the day it’s collected.

Sample integration with Statwing:
statwing

 

Final Thoughts

Just remember that even experienced survey designers struggle at times with developing the best structure for exploring a research question and setting up the systems to minimize the risk of collecting bad data. Hopefully this series on survey design for quality data has given you some ideas for how to approach your next project. And if there are any additional topics you’d like us to cover, please leave them in the comments.

Read Part 1 of the series here. This article was originally published on the SurveyCTO blog

About Alexis
Alexis Ditkowsky is the community and business strategy lead for Dobility, the company behind SurveyCTO. Her experience spans social entrepreneurship, international education policy, higher education, and the arts. She holds a Master of Education from the Harvard Graduate School of Education.

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Last week, Dobility founder and CEO Dr. Christopher Robert presented on how to design surveys for quality data in the TechChange course “Technology for Data Collection and Survey Design.” We thought it would be fun to share highlights from his talk with the larger community of mobile data collection users (while also showing off some of the cool ways that SurveyCTO can help you design smart surveys from day one).

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Lesson 1: Design For the People Actually Delivering Your Survey 

Enumerators have tough jobs. Imagine traveling for hours in extreme weather just to find respondents, who then have to be convinced to complete a survey that may take as long as three hours. Multiply this by your sample size and you can understand why your enumerators might be tempted to fake interviews or auto-answer questions.

One of the first steps in survey design is to be empathetic toward your field staff. Creating a survey that makes it easier for them to do their jobs while simultaneously making it harder to cut corners benefits everyone.

Lesson 2: Take Advantage of Relevance and Constraints 

Mobile data collection platforms can make survey design significantly easier than if you were creating a comparable paper-based survey. If a series of questions isn’t relevant, your survey can automatically skip them. You can also program your survey to ensure that the responses you get are more likely to be accurate. (Compare this to a paper-based survey where you often have to flip between sections and it’s all too easy to enter your data in the wrong section – or to fail to enter any data at all.)

Example 1: Relevance
As highlighted below, you can program your survey to display a question only if the respondent is female and older than 10. This might be useful if you have a series of questions on pregnancy – why waste time asking men if they’re pregnant? Not to mention, how would you log their responses if they DID say they were pregnant?

It’s always best to avoid collecting bad data in the first place rather than to worry about cleaning it up later.

Sample relevance field:
relevance

 

 

Example 2: Constraints
Let’s say you only want to interview people older than 18. With SurveyCTO, you can indicate a minimum value and a maximum value, you can make exceptions, and you can even create an error message that will display if the constraint is violated. Additionally, an enumerator won’t be able to progress in the survey until the question is answered properly.

Sample constraint field:
constraint

 

Final Thoughts

Taking the time to build in relevance, constraints, and some of the features we’ll discuss in our next post may feel daunting, especially if you’re pressed for time and trying to get a complex project off the ground. But as Chris likes to point out:

It’s worth it! Thoughtful survey design will return quality data that you can trust.

This article was originally posted on the SurveyCTO blog

About the Author
Alexis Ditkowsky is the community and business strategy lead for Dobility, the company behind SurveyCTO. Her experience spans social entrepreneurship, international education policy, higher education, and the arts. She holds a Master of Education from the Harvard Graduate School of Education.

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Live guest expert sessions are a key, and favorite, aspect of any of TechChange’s four-week, facilitated courses. Held 2-3 times per week, these events give our students the chance to engage with experts in the field and have active discussions. Our guest experts hail from diverse backgrounds and organizations.

Today, we had the opportunity to chat with Melissa Persaud, Director of Partnerships – North America at VOTO Mobile, who will be one of our guest experts for our upcoming mHealth: Mobile Phones for Public Health course. Melissa will be speaking during the second week of the course doing a demo of VOTO Mobile’s tools, before diving into a Q&A session with participants. Check out what she has to say about the field of mHealth!

Can you tell us about your background and experience in mHealth?

As a generalist and M4D enthusiast, I’ve been observing mHealth projects over the past 10 years. Personally, I’m excited by the possibilities technology provides in this space. From the household all the way to major hospitals, there is a role for tech. During my time with VOTO, I’ve been able to explore how pairing mobile phones and information can change and save lives.

How is mHealth incorporated to your work currently?

The beauty of VOTO is its ability to share information and promote behavior change at scale almost instantly. I get to spend my days collaborating with leading health organizations to adapt existing or design new approaches across all health needs. From finding ways to better support, train, and retain frontline and community health workers to thinking about how to disseminate critical and urgent outbreak information directly to households in real time, we are pushing the limits on what you can achieve with a basic mobile phone. I also benefit from learning from other sectors as we co-design projects across all sectors with international and local organizations around the world. For example, we’ve learned that calling Brazilians between 5-7 pm has a 4x higher response rate than 8-10 am. Sharing context-specific information like this helps us all be better development practitioners who provide even better services.

Why do you think mHealth is important / what impact can learning about the use of mobile phones for public health have on development projects?

In my mind, the health sector is one of the most diverse and complex ones out there and there is no silver bullet. With that said, tech does offer some significant enhancements to traditional health projects. You are able to reach more people directly, frequently, and cheaply. This can be incredibly useful ensuring adherence to life-saving drugs or vaccines and it was nearly impossible 15 years ago. Technology also allows us to map the spread of diseases, better understand high need areas, and allocate resources as necessary. Doctors can treat more patients and save lives through telemedicine services. Community health workers can instantly access treatment information for new diseases or rare cases they haven’t been trained on. The list goes on and on. What an opportunity!

What are your thoughts on the future of mHealth, and where you think this field is heading?

I’m particularly interested in demand driven content, where individuals can self-diagnose or learn more about health topics through their mobile phones. Think WebMD on your basic phone. A way people can learn more about their bodies and their health on their own time and without internet connectivity. I’m not sure if this is the future of mHealth, but I will be keeping an eye on it!

We believe mHealth skills have the potential to make a huge impact in your work. Why do you think taking this class is important, and who would you recommend it to (public health professionals, field workers, etc etc)?

One of the biggest challenges in mHealth is that practitioners don’t know where to start. The endless opportunities are often overwhelming and human nature is to stick with the things we know. One thing I hope the mHealth students takeaway from this course is how to think about the problem you are trying to solve and be able to make an informed decision on which mHealth tool will be most appropriate and successful. This skill will prove to be incredibly useful as students advance in their career, in health or otherwise.

Sound interesting and/or valuable to your work? Sign up for our mHealth: Mobile Phones for Public Health class here. Next session begins March 28, 2016!

About Melissa
Melissa Persaud is Director of Partnerships – North America at VOTO Mobile, a Ghana and US-based mobile engagement social enterprise. In her role, she builds and maintains partnerships with impact-oriented organizations in order to provide better choices for more voices around the globe. Personally, Melissa has a passion for program design and implementation, mobile for development (M4D), and financial inclusion. She holds a MPA in development practice from the SIPA at Columbia University and a BA from Lafayette College. Melissa is also a Returned Peace Corps Volunteer (Cameroon ’11-’13) and is currently based in Washington, D.C.

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