Launched: August 2014
Health workers are at the front lines for both routine health and for outbreaks of highly contagious diseases like Ebola. To fight back against endemic and epidemic diseases, health workers need to be equipped with the right information to prevent transmission, diagnose and treat patients, protect themselves, and mobilise communities. Robust two-way communication is the key to addressing priority health needs.
The Ebola virus causes acute illness characterised by the sudden onset of fever, fatigue, muscle pain, headache, and sore throat. Ebola is contagious once infected persons experience symptoms and the virus is transmittable through direct contact with the bodily fluids of infected persons, including material and surfaces contaminated with those fluids. The initial symptoms are typically followed by vomiting, diarrhoea, rash, impaired liver and kidney function, and even bleeding. Since its symptoms overlap with more common infectious diseases like malaria, typhoid, and meningitis, Ebola can be difficult to diagnose in resource-limited settings. There is no vaccine to prevent Ebola and there is no treatment proven to neutralise the virus, though early supportive care and treatment of specific symptoms increase the likelihood of survival.
The 2014 epidemic of Ebola has caused more cases and fatalities than all previous outbreaks combined, making it the largest and most complex episode of Ebola since its discovery in 1976. The Ebola outbreak was exacerbated by health systems weakened by long periods of conflict and instability, shortages of trained health workers, limited infrastructure, and burial practices where mourners were in direct contact with the deceased. The inability to report suspected cases, disseminate information, communicate with health workers, and collect real-time data were additional challenges.
In August 2014, UNICEF, USAID, and IntraHealth International organised a consortium of stakeholders and partner organisations to strengthen health information systems, enhance communication, and improve programme monitoring and evaluation. The consortium deployed mobile Health worker Electronic Response and Outreach (mHero) to combat Ebola in Liberia. mHero integrated information captured by iHRIS, an open source human resources information system that manages health worker data, with RapidPro. Linking these two systems together provided a powerful partnership that facilitated strong two-way communication between the Ministry of Health and Social Welfare, health care providers, and community health workers. Communication was enhanced to send specific messages tailored for health workers on their personal mobile phones; test knowledge and reinforce concepts; receive information on suspected cases, stock-outs of medical supplies, and updates on the spread of disease; and coordinate with Ministry of Health and Social Welfare.
mHero supported timely and informed decision-making for the Ebola response; increased health worker confidence related to Ebola prevention, diagnosis, and care; enabled real time notifications to emergency transporters; supported more efficient use of limited space in emergency treatment units and hospital beds; improved engagement and trust among health workers responding to Ebola; increased availability of health workers rallied for the Ebola response; decreased the time to receive test results so that patients negative for Ebola could be separated from those patients with an unknown Ebola status; and promoted adequate supply of personal protective equipment, essential medicines, and decontamination supplies to protect health workers and suppress transmission.
mHero Ebola has demonstrated the ability to quickly deploy a mobile solution to resolve communication issues during times of crisis. However, mHero’s SMS and voice capabilities can be applied to any area of health where two-way communication with frontline workers would be beneficial. These capabilities include verification, alerts, and notifications; structured messages to assess and reinforce concepts; targeted messages for follow up with specific subpopulations; personalised messages and group chat for encouragement and peer support in difficult operating environments; routine reporting and aperiodic survey; and support for supply and logistics. Many of these functions are currently deployed in areas where polio is still endemic. mHero can be used to support frontline health workers in their efforts to provide primary health care services or respond to the next outbreak of an infectious disease. mHero is a sustainable solution to strengthen health systems and improve health.