FIND, the Earth Institute and Uganda's Health Ministry collaborate to improve malaria reporting

Carol Asiimwe (FIND) and David Gelvin (IT consultant) checking RapidSMS reporting with Enoch Tumwesigye (Surveillance Officer, MOH-Uganda) at Kabale District HQ in Uganda (photo courtesy of Tony Murdoch)

David Gelvin and Enoch Tumwesigye reviewing RapidSMS reporting charts (courtesy of Tony Murdoch)

The accuracy of paper-based data reporting on malaria from the field has long been a concern for health policy managers and may at times have led to erroneous interpretations of qualitative and quantitative trends. These inherent drawbacks have now been largely overcome with the introduction of a system which requires only simple inputting on a mobile phone. The results are then automatically interpreted in more complex chart or graph form by a remote computer.

To help fight malaria, and other pandemic diseases, the Swiss non-profit organization FIND, Columbia University’s Earth Institute, and the Ugandan Ministry of Health (MOH) have developed and launched a health monitoring system based on text messaging (SMS, or short message service). Initially created by UNICEF, RapidSMS is a free and open-source framework for dynamic data collection, logistics coordination and communication. The primary goal of the partnership is to support the compilation of data on malaria cases, the use of malaria diagnostics, stocks of anti-malarial commodities, and disease surveillance by health units located in remote areas in Africa.

Ministries of Health and other agencies depend on gathering timely and accurate data from the field in resource-limited areas where the majority of people seek care and treatment for malaria. Such information is essential not only for national health authorities to accurately track malaria cases but also in order to efficiently manage stocks of diagnostics and drugs which are in limited supply. Since internet coverage is still inadequate in many of these areas, and fixed landline telephone coverage is too low to sustain the need for rapid and regular information sharing, most MOHs depend on paper-based reporting systems.

RapidSMS - leveraging available technologies to meet the needs of national disease control programs

The explosive growth of mobile telephone services, even in low income countries, offers opportunities to build on existing infrastructure to develop innovative approaches to transmit vital healthcare-related data in near real-time.

In its 2009 report on Uganda activities, the Global Fund to Fight AIDS, Tuberculosis and Malaria (GF) identified a number of risk factors such as the poor state of medical warehouses; non-transparent procurement processes; non-timely submission of progress updates and disbursement requests; disbursement delays; weak coordination and the low capacity to report stock management and forecasting. Also missing was the systematic collection and monitoring of relevant information.

The RapidSMS reporting system was launched in Uganda in early November 2009 and covers 127 health workers from 45 health units in Gulu district and 247 health workers in 113 health units in Kabale district. Gulu, which is emerging from a 20 years old rebel war, is located in northern Uganda with a population of 479,500. Kabale, with a population of 43,500, is situated to the west, approximately 10 km from the Rwandan border. Its population is prone to malaria, with infective mosquito bite rates/person/year at 0.4. Uganda has a total of 81 districts, which are divided into four 4 regions.

During this period, peripheral health centers using the system had a 91 percent reporting rate, with a total of 924 out of 1015 expected reports sent. These covered four weekly text messages per health center containing epidemiology data on malaria diagnosis, malaria treatment and ACT stocks. The high compliance rate has been achieved without using alerts, and importantly for sustainability, without using monetary or other extraneous incentives. Since this type of reporting replaces the need for clinics to send paper forms, Uganda’s MOH is considering officially accepting the RapidSMS reporting system as a complement to ensure prompt reporting of weekly data. This will permit healthcare workers to improve the quality and timeliness of the more comprehensive paper-based reports that health centers submit on a monthly basis. 

SMS data is made available in a web-based dashboard to program managers in the Ministry of Health at the district and national levels. The Kabale district has already reported using the system to redistribute ACTs based on stock data received by the RapidSMS system.

Based on the early success of this project, discussions are continuing between the MOH and key stakeholders to roll out this monitoring system to other districts and disease areas in the country. This system is affordable (SMS costs are $US 0.6-1 per health unit/week), and, because it is based on open-source software, customizable to meet country-specific requirements.
 

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FIND is a non-profit organization established in 2003, based in Switzerland with offices in Uganda and India. Its mission is to develop, evaluate, demonstrate, and accelerate the implementation of new diagnostic tests and platforms for poverty-related diseases, including TB, malaria, and HAT. Increasingly, FIND’s approach to diagnostics development is targeted at technological platforms that can address diagnostic needs across disease areas, and that can also be implemented at levels of the health care system closer to where patients first seek care. FIND has active collaborations with over 100 partners, including research institutes/academia, Ministries of Health, commercial partners, bilateral and multilateral organizations, especially WHO, and clinical trial sites.

The Earth Institute at Columbia University mobilizes the sciences, education and public policy to achieve a sustainable earth. Through interdisciplinary research among more than 500 scientists in diverse fields, the Institute is adding to the knowledge necessary to address the challenges of the 21st century and beyond. With over two dozen associated degree curricula and a vibrant fellowship program, the Earth Institute is educating new leaders to become professionals and scholars in the growing field of sustainable development. We work alongside governments, businesses, nonprofit organizations and individuals to devise innovative strategies to protect the future of our planet.

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