Country of Operation
SummaryD-tree International uses clinical protocols to develop clinical decision support software that can be loaded onto mobile phones for use by Clinic staff and Community Health Workers (CHWs) to help them accurately assess, diagnose and treat patients.
The acute shortage of physicians and nurses is severely limiting the care and treatment available to patients of all types. These factors have contributed to a growing interesting in task shifting, i.e. delegating routine tasks being performed by physicians to other categories of health workers. The key to success of task shifting is the ability to maintain high standards of care despite the use of non-physicians to provide care and treatment to patients. Therefore, D-tree International aims to improve adherence to clinical protocols through the use of mobile phones.
Key program components
D-tree International implements several programs based around the creation of algorithms on mobile phones (D-tree originally used PDAs, but has since entirely switched to phones). These protocols prompt a nurse or other health worker to ask each patient a series of questions regarding their treatment or other health problems and determine where a patient requires the attention of a physician.
Pilot programs, mainly centered in Tanzania, but also taking place in South Africa, India, and Malawi, have been created around several health concerns. Projects on HIV/AIDS, Integrated Management of Childhood Illness (IMCI), antenatal, neo-natal and post-natal care, reproductive health, malaria, diabetes, tuberculosis have all been implemented thus far.
D-tree International has adapted the IMCI protocols for use on mobile phones (eIMCI). These classify and recommend treatment for common causes of death including pneumonia, diarrhea, malaria, measles and malnutrition among children. The software developed guides health workers step by step through the full IMCI assessment, classification, and treatment plan.
Through this pilot, D-tree has shown that providers at health facilities are better able to follow the electronic protocols than the current standard of paper based protocols leading to improvements in diagnosis and treatment, simultaneously increasing adherence to these protocols and reducing the inappropriate prescription of antibiotics and anti-malarials for children with fever.
D-tree International is also working in the area of family planning where they are developing a screening protocol for use by community and facility based health workers to suggest methods of contraception as well as to prompt health workers for types of advice to give each client during each visit.
In the area of diabetes care, D-tree aims to improve the quality of care available to patients with NCD’s through the use of electronic algorithms that are linked to an electronic patient record.
The e-TB module is used once a patient is suspected of having TB, based on standardized screening questions about coughing, sweating, fevers, etc. These questions have been added to the e-CTC system, and trigger referral to TB care.
Mobile Money enables the payment of services to be done via a mobile device.
By Ilan Shahin, Raman Sohal, Will Mitchell, and Onil Bhattacharyya.