Overview

This project aims to lessen the workload on community health care workers through the use of mobile technologies and thereby improve care and competency networks and augment current social and care networks in Ndumo, KwaZulu-Natal.

The project will be a partnership between HIV-911 Programme, AMREF and Cell-Life. While planning has begun (a site visit to Ndumo took place in January 2009) the implementation phase of this pilot will take place over the period of one year – from approximately April / May 2009 to March 2010.

Pilot Site

For this pilot phase, we will restrict ourselves to the rural community of Ndumo, KwaZulu-Natal, and specifically work with the Ndumo Community Care Centre and their partner organisations. As such, we will make available via the USSD, menu-driven facility, to this specific target audience, a subset of the HIV-911 data, applicable to that
area.

Project Partners

AMREF are PEPFAR funded through USAID under Anita Sampson. AMREF will cover the costs of community mobilization, community training, and the transport
and accommodation logistics for all team members associated with the project. They will also continue to cover the costs of having personnel onsite in Ndumo.

Cell-Life are funded through DTI, Elton John AIDS Foundation and Vodacom Foundation and will cover all technical development costs relating to the
mobile pilot and all text messaging costs.

HIV-911 are funded through USAID/PEPFAR via a sub-contract with Foundation for Professional Development and via another sub-contract with Population
Council and the National Department of Social Development. As a result, HIV-911 will be responsible for updating data on service providers in the Ndumo area and all other areas of South Africa; providing service providers in the the Ndumo community with service referral support; developing the technology in partnership with Cell-Life and AMREF for a mobile pilot in Ndumo; and providing training expertise for community development and all HIV-911 related activities in the area. HIV-911 will fund the salary costs for Debbie Heustice, Catherine Jenkin and data collection staff, relevant database development and related IT costs (the latter will be largely supported by Cell-Life).

Step 1: Connecting Clients to HIV-911 Database

This project will utilise the HIV-911 USSD, menu-driven interface which makes accessible to mobile handset users, the HIV-911 database via calling
*120*448#. This USSD, menu-driven interface for the HIV-911 database is being developed in partnership with Cell-Life.

As such, when a user calls this string via their handset, they will be presented with the top six service categories on the HIV-911 database.
These will be selected and narrowed down from the following ten primary service categories:

Children’s Services Menu:

• Educational Support (to incorporate educational support and early childhood development and child care/day care)
• Psycho-Social Support
• Nutritional Support
• Primary Health Care (to incorporate the Primary Health Care main category)
• Life Skills Training
• Treatment (to incorporate the Treatment main category)
• Child Abuse Prevention, Therapy & Treatment
• Grants

These categories will be tested with the community to ascertain their need for such services.
Once a service is selected, the user can then select their Municipality and the service will then feed back a list of service providers in that
location. Information to be included will be: Service Provider/Organisation and contact telephone number.

Step 2: Creating a Local Referral System

The user will then be able to SMS that Service Provider to make an appointment/refer a client/make an enquiry. The service provider would
designate one key contact for this purpose and the service provider would be able to send a confirmatory SMS to indicate whether the appointment is
acceptable or if a change is needed. We would prefer to establish a set of prescribed responses for reply so as to prevent system abuse. This closed
user group could use a GPRS framework which would enable more management, tracking and reporting to occur in a more seamless fashion. Cell-Life would
work with HIV-911 to accomplish this.

As such, the cost of this contact to and from the Service provider will be borne by the Cell-Life project, and not by the mobile user.

Step 3: Ability to Access Frequently Asked Questions
This will come on track down the line and will involve AMREF and HIV-911 putting together answers to frequently asked questions so that the community/community health workers have these solutions / this information at their disposal rather than having to connect with other service providers for these answers.

Controls, Monitoring and Evaluation

In terms of management and reporting, we wish to be able to track the interactions between service provider and user, and further follow up interactions, both from a qualitative and quantitative standpoint. For Step 2 to be effectively tracked, we expect that it will be necessary to set up a closed user group initially consisting of one key contact (one cell phone number) at each of the service points in Ndumo and each of the members of the group of 30 Community Health Workers / AMREF staff in the area. As such, the public would not have access to the free facility to contact service providers and would need to work via the Community Health Workers and AMREF staff to connect to service providers via the pilot free system. This would not prevent the public from using the USSD system described in Step 1 (for free) and then contacting service providers themselves (via their own phones or in person etc).

The Partners identified above are described in the section below:

Cell-Life – A brief overview:

Cell-Life is a pioneering initiative that provides effective technology-based solutions for the management of HIV/AIDS. Cell-life exists to address logistical challenges in developing countries, such as the provision and distribution of Anti-Retroviral Treatments (ART), continuous patient monitoring and communication of relevant data. This is achieved through the use of innovative software supported by existing technologies such as mobile phones and the Internet. As a result, Cell-Life has been funded to see how mobile technology can be of use in the HIV sector.

HIV-911 Programme – A brief overview:

HIV-911 specializes in data collection and referrals to nearly 10 000 HIV/AIDS-related service providers in the country. HIV-911 also creates networking opportunities for service providers to more effectively connect with one another, locate and recommend supplementary support services for their clients. HIV-911 acknowledges the
generous support of the American people through USAID/PEPFAR.

As HIV-911 is a leading organization in the HIV/AIDS sector, with access to a vast and dynamic database of HIV service providers (currently over 8 500
across South Africa), it is mutually beneficial for Cell-Life and HIV-911 to collaborate. The ultimate objective of this collaboration is to expand the reach and usability of HIV-911 as a data provider by making it possible for the database to be accessed via mobile phones. Cell-Life will work with HIV-911 over a period of time to develop the necessary technology to facilitate this process. This will be a phased process as technology is developed. The Cell-Life /HIV-911 collaboration will also provide HIV-911
with a free text messaging facility (SMS) so as to enable HIV-911 to communicate more actively via SMS with stakeholders, whether these stakeholders are members of the HIV-911 database; clients wanting to access information from the database or members of the HIV-911 staff. HIV-911 has applied these benefits to their work on the Ndumo Project to mutual benefit.

AMREF – A brief overview:

AMREF aims to improve the health of disadvantaged people in Africa as a means for them to escape poverty and improve the quality of their lives. AMREF defines the disadvantaged as people who suffer a high prevalence and impact of major health problems and challenges including Malaria, HIV/AIDS, Adolescent and Reproductive Health, Water and basic Sanitation and have poor access to Health Care. The office in South Africa was opened in 1995. AMREF is a PEPFAR-funded site. As part of this programme AMREF have sites in several provinces. AMREF are working with HIV-911 on the Ndumo Community Mobile Pilot Study for which they are able to provide on site staffing and funding for local workshopping / mobile interface training and related expenditure.

HIV-911 and AMREF held a community briefing meeting in February 2009, with great success. Stakeholders at the meeting included Community Health Care
Workers, Hospital staff, SAPS officers and local traditional leaders. Through briefing and contextualizing the proposed pilot, HIV-911 and AMREF sought to encourage community involvement in this mobile pilot. Huge support has been garnered from the community and, as such, HIV-911 and AMREF feel confident that the imminent roll-out of this pilot will be actively supported by the community.