BOROUGH OF BARNET-ARGENTI CARE TECHNOLOGY (UK)

• The London Borough of Barnet wanted to improve support of patients with complex learning disabilities in supported living facilities.
• Through the Local Investment Programme (2017-2018) under the National Health Service digital funded Social Care Programme, they partnered with Argenti Care Technology to develop a personalized, independence-enhancing solution for patients in supported living facilities.
• The Local Investment Programme (LIP) was developed to enhance digital maturity in the adult social care provider as related to the health sector. LIP was the result of a London council-led innovation to increase the use of digital technology in health and social care.
• The goals of the Barnet-Argenti program were to increase non-intrusive care as well as provide faster response to issues and emergencies.

• The Borough worked with Argenti to engage and communicate with care providers as well as service users and families.
• The Borough also pre-assessed users of the care technology to determine awareness as early interviews showed there was limited knowledge of technology available.
• Based on these assessments and communication, a personalized care technology for patients with complex disabilities was developed and rolled out in the care provider facilities.
•  Potential savings from use of technology were identified and tracked.

• The Borough and Argenti reported that target was exceeded with 22 service users in 3 care providers in the Borough being supported.
• Outcomes included increased quality in daily life of patients as well as quicker response to their needs.
• The Barnet Council also reported cost savings of nearly £20,000 for March 2018 and up to £152,666 in projected yearly savings.
• The program faced implementation challenges as service users were initially technology-averse and worried that human interaction will be reduced.
• This was resolved through pre-assessment and communication assuring service users that technology could be helpful in providing quicker assistance from the facility staff.
• The Borough stated that the program could be used to promote data and monitoring analytics to better serve health patients.
• The Barnet-Argenti project could also be used as an example of a technology-structured care program to other boroughs and local government units.

RWANDAN MINISTRY OF HEALTH-ONE FAMILY HEALTH (RWANDA)

•  Majority of the population in Rwanda live in rural and mountainous areas, resulting in limited access to health care services.
• The Rwandan Ministry of Health wanted to provide entry-level healthcare access within the radius of a 30-minute walk through the establishment of health posts or small primary care clinics.
• The Ministry partnered with One Family Health (OFH) to build a network of rural franchise health posts or small clinics owned and operated by local nurses.
• The program was made possible by the use of an entrepreneurial health model and supported by the national health insurance fund.

• The Ministry and OFH established the network of health posts by recruiting Grade A2 College nurse graduates with 5-8 years of experience. They were given a rent-free building in their own villages to provide care.
• Nurses were trained and given mobile phones equipped with real-time analytics to support electronic patient records, monitoring, billing and stock ordering.
•  Trained nurses were enrolled in the OFH network and assigned to a district supervisor for guidance and support.
•  Nurse-franchisees received compensation from the Rwandan community insurance scheme (Mutuelle de Santé) as well as from co-payments given by the patients.

• The Rwandan Ministry reported that over 90 health posts or nurse-franchises were established, each receiving up to 40 patients per day.
• OFH reported that basic health services were provided to more than 500,000 patients.
•  Travel time of patients were cut down from 74 minutes to 14 minutes as a result of the rural franchise health posts network.
• The program shows that universal health coverage in spite of a lack of resources was made possible through a public-private partnership.
• Though public health budget was limited, the program leveraged the national health insurance fund to apply an entrepreneurial health model and enable government delivery of health service in hard to reach areas.

MALAWI MINISTRY OF HEALTH-VILLAGE REACH (MALAWI)

• Malawi has one of the highest maternal and infant mortality rates in the world, with a mother having 1 in 34 chance of dying while giving childbirth.
• The Malawi Ministry of Health wanted to provide access to maternal and child health care especially in rural areas, where myths and misinformation also pervade communities.
• The Ministry partnered with Village Reach to provide on-demand mobile message service to deliver information on maternal and child health.
• The mHealth facility personalized informational messages to a mother's stage of pregnancy or their child's age.
• A general toll-free hotline was also made available for general health service such as triage call to physicians and referral to village clinics or hospital.

• Together, VillageReach and the Malawi Ministry of Health established Chipatala Cha Pa Foni (CCPF) or "health centre by phone", an mHealth facility for rural residents.
• Health staff were trained to respond to health inquiries according to the Ministry of Health and Population's guidelines. They also referred callers to health facilities as needed.
• The mobile message service also provided information about maternal and child health through opt-in text and voice messages.
• The mHealth facility is powered by an interactive voice response system that enables mothers to retrieve messages on demand.

• After the Ministry initiated CCPF in one district, VillageReach expanded the mHealth facility to 9 districts, providing access to over 5 million residents in rural areas.
• CCPF cut down the burden on rural health facilities and workers by 75% as health inquiries and concerns were resolved over the hotline.
• CCPF users reported increased awareness of maternal health services available to them. It also impacted their knowledge of maternal health, leading to a change in behavior.
• Rural residents who used CCPF were able to save time and travel costs.
• Although the program faced challenges in terms of sustainability and scale in the beginning, a partnership with Airtel (Africa's biggest mobile carrier) made zero-rating of the calls to the mHealth facility possible.
• In July 2017, the Malawi Ministry of Health signed a memorandum to scale and sustain CCPF, with the goal of covering all its 28 districts.