Use of an Innovative, Affordable, and Open-Source Short Message Service–Based Tool to Monitor Malaria in Remote Areas of Uganda

Abstract

Quality health management requires timely and accurate data, and paper-based reporting does not fill this role adequately. The introduction of malaria rapid diagnostic tests and the availability of wireless communications present an opportunity to open direct data transmission and feedback between peripheral health workers and central managers. In November 2009, the Uganda Ministry of Health deployed a short message service–based reporting system in two districts. At a set-up cost of $100/health facility, local technician support of $ 400 per month, and a cost of $0.53/week/clinic, the SMS reporting system was started at more than 140 clinics. Positivity rates for rapid diagnostic tests and artemisinin combination therapy stock outs were 48% and 54% in Kabale and 71% and 54% in Gulu, among other reports, at more than 85% health facilities reporting weekly and without monetary incentives or additional supervision. The SMS-based reporting systems have potential to improve timeliness in reporting of specific, time-sensitive metrics at modest cost, while by-passing current bottlenecks in the flow of data. With the development of specific capacity to manage stock data at district level, the availability of timely data offers potential to address commodity distribution problems and reduce stock-outs.

Integrating mHealth at point of care in low- and middle-income settings: the system perspective

“…Only 7% of broadband subscriptions in low-income countries have broadband speeds of 10 Megabits per second or higher (Table 1) [2], and multiple studies cite this poor network connectivity as a challenge [22–24]. These problems are seen even where mobile infrastructure is better developed than in many LMICs; in an urban South African image-based burn care pilot, transmission of images 1MB in size used up to 50MB of data as the app continually tried to push the image to the server, only to be interrupted multiple times prior to completion as the network dropped (Pajat Solutions Oy F, Personal communication from the app host 2016 Dec 6).…”

“…Pilot programs often have funding for the initial development and study, but if they do not plan and budget for ongoing app maintenance then they are unlikely to go to scale. Such a pilot in Kenya found that the cost of technical support needed for their malaria surveillance program would be around GBP 260 per month, which while not a prohibitive cost can stop wider uptake if it is not budgeted appropriately [24]. In a Chinese pilot, low smartphone ownership rates were overcome by issuing participants with phones preloaded with the application; unfortunately the project leads did not foresee that updating the app would require them to purchase new phones and reissue them to all of their front-line users, making the project unsustainable [25].…”

A demonstration of mobile phone deployment to support the treatment of acutely ill children under five in Bushenyi district, Uganda

“…23 Mobile phones have been widely used in recent years to enhance data management, 24 and improve communication among providers. 25 Positive influences on health have been shown at a system level in low-resource settings. 26 Phones have been demonstrated to have significant impact on adherence to therapeutic regimens and on anti-infective clinical outcome indicators in countries such as Kenya.…”

Malaria elimination: needs assessment and priorities for the future

“…In some remote parts of Africa, landline phones, fast internet access, computers and paved roads are not readily available for the effective transfer of disease information [48]. Also, mobile phones and short message service (SMS) technology can form the basis of synchronized disease detection systems and integrated intervention efforts [49]. These communication tools can allow researchers to effectively collect and share data and enhance the routine reporting of malaria parameters such as antimalaria drug supplies at health facilities [49].…”

“…Also, mobile phones and short message service (SMS) technology can form the basis of synchronized disease detection systems and integrated intervention efforts [49]. These communication tools can allow researchers to effectively collect and share data and enhance the routine reporting of malaria parameters such as antimalaria drug supplies at health facilities [49]. Nevertheless, more research is needed on the effect of economic growth on malaria elimination, on countrylevel health systems and circumstances and on their readiness to introduce and sustain novel programs and interventions [34].…”